Provider Demographics
NPI:1972636413
Name:ST. JOHN, GREGORY S (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:ST. JOHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16429 VILLAGE PLAZA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4913
Mailing Address - Country:US
Mailing Address - Phone:636-458-9300
Mailing Address - Fax:
Practice Address - Street 1:16429 VILLAGE PLAZA VIEW DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63011-4913
Practice Address - Country:US
Practice Address - Phone:636-458-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0147181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice