MEDICARE: TOM SOTIROPOULOS METRO DENTAL SLEEP MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	2017028549	MO

General Provider Information

NPI Number	:	1245742204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM SOTIROPOULOS METRO DENTAL SLEEP MEDICINE

Provider Business Mailing Address
First Line	:	1681 LANCASTER DR
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-6780
Country	:	US
Telephone Number	:	618-444-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 WALSH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2859
Country	:	US
Telephone Number	:	314-849-5555
Fax Number	:	314-675-9955

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS DEAN SOTIROPOULOS
Credential	:	DDS
Telephone Number	:	618-444-3274

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	09/06/2022

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