NPI 1043479215

Numpol Dejtiranukul DMD LLC

Organisation General Practice Dentistry O Fallon, MO

Practice location

Address: 4122 Keaton Crossing Blvd Suite 101, O Fallon, MO 63368-8218
Phone: (636) 300-4280

Authorised official

Name: Numpol Dejtiranukul
Title: Single Member
Phone: (636) 300-4280

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 2000170243 (MO)

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Registry record

NPI: 1043479215
Entity type: Organization
NPI issued: 3 Jun 2008
Record last updated: 3 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.