NPI: 1184892028
Provider Name: GATEWAY ORAL AND MAXILLOFACIAL SURGEONS OF ST LOUIS, P.C.
Former Legal Business Name: TRAVIS & NOLEN ORAL & MAXILLOFACIAL SURGERY, P.C.
Classification: Dentist - 1223S0112X
Entity Type: Organization
Specialization: Oral and Maxillofacial Surgery
CLIA Number: 26D2057371
Address:
165 N. MERAMEC AVE
SUITE 300
CLAYTON, MO
ZIP 63105
Phone: (314) 726-2755
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GATEWAY ORAL AND MAXILLOFACIAL SURGEONS OF ST LOUIS, P.C. is an oral and maxillofacial surgery dentist in Clayton, MO. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. GATEWAY ORAL AND MAXILLOFACIAL SURGEONS OF ST LOUIS, P.C. NPI is 1184892028. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Travis & Nolen Oral & Maxillofacial Surgery, P.c..
The provider's business location address is:
165 N. MERAMEC AVE
SUITE 300
CLAYTON, MO
ZIP 63105-772
Phone: (314) 726-2755
Fax: (314) 726-9538
The provider's authorized official is Daun M. Brandt .
The authorized official title is Business Manager and has the following contact phone number (314) 726-2755.
The CLIA number assigned to this NPI record is 26D2057371 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 2/13/2008 and was last updated on 4/11/2023.