Provider Demographics
NPI:1023753241
Name:GARDEN HEIGHTS LLC
Entity type:Organization
Organization Name:GARDEN HEIGHTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-443-5205
Mailing Address - Street 1:1710 GRATZ BROWN ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1913
Mailing Address - Country:US
Mailing Address - Phone:636-443-5205
Mailing Address - Fax:573-615-0793
Practice Address - Street 1:1608 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-2208
Practice Address - Country:US
Practice Address - Phone:314-645-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental