Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2005024545 | MO |
NPI | 1376580118 |
---|---|
Provider Name | Steven T Vennard |
First Address | Chesterfield, MO 63005-1361 |
Second Address | Chesterfield, MO 63005-1361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |