Provider Demographics
NPI:1538567110
Name:ARNOLD ENDODONTICS - SHELLY L. SARICH DDS
Entity type:Organization
Organization Name:ARNOLD ENDODONTICS - SHELLY L. SARICH DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SARICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:636-379-4500
Mailing Address - Street 1:4123 JEFFCO BLVD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-4215
Mailing Address - Country:US
Mailing Address - Phone:636-223-7070
Mailing Address - Fax:636-223-2669
Practice Address - Street 1:4123 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-4215
Practice Address - Country:US
Practice Address - Phone:636-223-7070
Practice Address - Fax:636-223-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty