St. Louis South Oral & Maxillofacial Surgery, Inc. – Oral and Maxillofacial Surgery (Dentist), NPI 1366657405

St. Louis South Oral & Maxillofacial Surgery, Inc. is a healthcare provider. based in Festus, Missouri. specializing in Oral and Maxillofacial Surgery (Dentist). The organization holds a License No. 015277 (MO). The NPI Number for St. Louis South Oral & Maxillofacial Surgery, Inc. is 1366657405

Main info

Organization
Name
St. Louis South Oral & Maxillofacial Surgery, Inc.
NPI
1366657405
Phone
(636) 931-4699
Address
1155 E GANNON DR
Authorized Official
MS. PEGGY S. CAROTHERS OFFICE MANAGER
Enumeration Date
11 May 2007
Last Update Date
22 August 2020
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness80
Years active:19State licenses:1Digital endpointsUpdated within 12 months

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Provider Addresses for St. Louis South Oral & Maxillofacial Surgery, Inc.

  • 1155, East Gannon Drive, Festus, River View Township, Jefferson County, Missouri, 63028, United States

    FESTUS, MO 630282611

    Phone: (636) 931-4699

    Fax: (636) 931-5110

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

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Medicare Enrollment & Revalidation

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No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

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No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 63028)

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Frequently asked questions

What NPI should I save for St. Louis South Oral & Maxillofacial Surgery, Inc.?
Save NPI 1366657405 if you need a stable reference for St. Louis South Oral & Maxillofacial Surgery, Inc..
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An active flag here means the NPI record is not in a deactivated state.
What kind of provider is St. Louis South Oral & Maxillofacial Surgery, Inc.?
The page reflects Oral and Maxillofacial Surgery (Dentist) for St. Louis South Oral & Maxillofacial Surgery, Inc.. Clinical services aligned with this taxonomy classification.
What location metadata exists for St. Louis South Oral & Maxillofacial Surgery, Inc.?
The page summarizes Festus, Missouri for St. Louis South Oral & Maxillofacial Surgery, Inc.; expand the address list for detail.
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