Provider Demographics
NPI:1699120287
Name:ERIN S. SCIMONE, D.M.D. LLC
Entity type:Organization
Organization Name:ERIN S. SCIMONE, D.M.D. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-267-2235
Mailing Address - Street 1:4607 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2749
Mailing Address - Country:US
Mailing Address - Phone:314-481-3369
Mailing Address - Fax:314-481-5386
Practice Address - Street 1:4607 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2749
Practice Address - Country:US
Practice Address - Phone:314-481-3369
Practice Address - Fax:314-481-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120154011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1538414826OtherINDIVIDUAL NPI