Provider Demographics
NPI:1144348681
Name:TEGENKAMP, ANTHONY JOHN IV (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:TEGENKAMP
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3802 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1384
Mailing Address - Country:US
Mailing Address - Phone:314-842-2038
Mailing Address - Fax:314-842-8498
Practice Address - Street 1:3802 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1384
Practice Address - Country:US
Practice Address - Phone:314-842-2038
Practice Address - Fax:314-842-8498
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO016061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist