Provider Demographics
NPI:1306343488
Name:ASHOK K ROHRA JR DDS , LLC
Entity type:Organization
Organization Name:ASHOK K ROHRA JR DDS , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROHRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS , MSD
Authorized Official - Phone:314-624-9373
Mailing Address - Street 1:11255 OLIVE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7652
Mailing Address - Country:US
Mailing Address - Phone:314-624-9373
Mailing Address - Fax:
Practice Address - Street 1:11255 OLIVE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7652
Practice Address - Country:US
Practice Address - Phone:314-624-9373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180003191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty