Numpol Dejtiranukul Dmd LLC

NPI #1043479215 in O Fallon, Missouri

Provider Information

NPI Number: 1043479215
Entity Type: Organization
Organization Name: Numpol Dejtiranukul Dmd LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 3, 2008
Last Updated: Jun 3, 2008

Practice Location

Address: 4122 KEATON CROSSING BLVD
Address 2: SUITE 101
City: O Fallon
State: Missouri
ZIP Code: 63368-8218
Phone: (636) 300-4280

Authorized Official

Name: DR. NUMPOL DEJTIRANUKUL, DMD
Title: SINGLE MEMBER
Phone: (636) 300-4280

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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