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Provider Information for 1003920174

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. MICHAEL EDLIN JR. D.M.D

Gender: MALE

Individual NPI: 1003920174

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1003920174
Enumeration Date 2006-08-18
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 8000 BONHOMME AVE. SUITE 306
ST. LOUIS, MO 63105
United States

Phone: 314-863-2222 | Fax: 314-863-5225
View Map External Link
Primary Practice Address 8000 BONHOMME AVE SUITE 306
SAINT LOUIS, MO 63105-3515
United States

Phone: 314-863-2222 | Fax: 314-863-5225
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice MO 14966