Provider Demographics
NPI:1174619514
Name:LOUISE R FIRST DMD PC
Entity type:Organization
Organization Name:LOUISE R FIRST DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:FIRST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-837-2120
Mailing Address - Street 1:77 W PORT PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3121
Mailing Address - Country:US
Mailing Address - Phone:314-837-2120
Mailing Address - Fax:314-838-8400
Practice Address - Street 1:77 W PORT PLZ STE 205
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3121
Practice Address - Country:US
Practice Address - Phone:314-837-2120
Practice Address - Fax:314-838-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL015538122300000X
332B00000X
MO015538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty