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Deactivated NPI 1821153073 Deactivated / Inactive NPI Male Practitioner

Dr. Samuel D. Dednam , DMD

Dentist - General Practice • Saint Louis, MO

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Samuel Dednam has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date December 27, 2006
NPI Deactivation Date July 14, 2017
Total Practice Duration ~11 Years of Practice (2006 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. Samuel Dednam, DMD was a registered Dentist - General Practice practicing in Saint Louis, MO. Throughout an active medical career spanning 11 years, Dr. Dednam provided care at the practice location at 3535 S JEFFERSON AVE STE 302 until profile deactivation on 2017-07-14.

Practice Location & Contact Primary Location

Practice Address

3535 S Jefferson Ave Ste 302

Saint Louis, MO 631183935

Telephone 3142686135
Fax 3142686117
Associated Practice Facility / Clinic
🏢 Senior Care Dentistry Facility NPI 1457599664

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Saint Louis, MO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 9.5 Yrs
Regional Practice Density
270 Specialists

Practicing in Saint Louis, MO (2113 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MO 012412

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Kourtenay Green , DDS

Dentist - General Practice

NPI 1811049091

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated July 14, 2017

Record deactivated on July 14, 2017

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 09, 2007

Registered at 3535 S JEFFERSON AVE STE 302, SAINT LOUIS, MO 631183935 (Tel: 3142686135)

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Updated Business Mailing Address July 09, 2007

Registered at 6405 VIRGINIA AVE, SAINT LOUIS, MO 631112706 (Tel: 3144812284)

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Provider Name / Credentials Updated July 09, 2007

Recorded as SAMUEL DEDNAM, D.M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Dentist (License #012412 in MO)

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Initial NPI Registration & Enumeration December 27, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1821153073
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 27, 2006
Last Update: July 09, 2007
Deactivation Date: July 14, 2017

Mailing Address

6405 Virginia Ave

Saint Louis, MO 631112706

Phone: 3144812284

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.