Provider Demographics
NPI:1548352289
Name:DEDRICKSON, STEVEN RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAY
Last Name:DEDRICKSON
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 1:7777 BONHOMME AVENUE
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105
Mailing Address - Country:US
Mailing Address - Phone:314-721-2466
Mailing Address - Fax:314-725-5311
Practice Address - Street 1:7777 BONHOMME AVENUE
Practice Address - Street 2:SUITE 1900
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105
Practice Address - Country:US
Practice Address - Phone:314-721-2466
Practice Address - Fax:314-725-5311
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist