Provider Demographics
NPI:1902978612
Name:VARBLE, AMY (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:VARBLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 BLUESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5977
Mailing Address - Country:US
Mailing Address - Phone:618-531-7819
Mailing Address - Fax:
Practice Address - Street 1:549 MAPLEVIEW DR
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-3813
Practice Address - Country:US
Practice Address - Phone:618-531-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY87061223P0221X
MO20060025361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9179212Medicaid
MO400246708Medicaid