MEDICARE: SLEEP DISORDER DENTISTRY LLC

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	122300000X	Dentist
2	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE015391	OTHER	MO	INSURANCE

General Provider Information

NPI Number	:	1396113080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DISORDER DENTISTRY LLC

Provider Business Mailing Address
First Line	:	1338 BIG BEND SQUARE SHOP CTR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-7618
Country	:	US
Telephone Number	:	636-394-9587
Fax Number	:	636-394-9624

Provider Business Practice Location Address
First Line	:	1338 BIG BEND SQUARE SHOP CTR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-7618
Country	:	US
Telephone Number	:	636-394-9587
Fax Number	:	636-394-9624

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN POSTOL
Credential	:	DDS
Telephone Number	:	636-394-9587

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	01/22/2026

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Directions to “SLEEP DISORDER DENTISTRY LLC ” Practice Location

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