Healthcare Provider Details

I. General information

NPI: 1396113080
Provider Name (Legal Business Name): SLEEP DISORDER DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 BIG BEND SQUARE SHOP CTR
BALLWIN MO
63021-7618
US

IV. Provider business mailing address

1338 BIG BEND SQUARE SHOP CTR
BALLWIN MO
63021-7618
US

V. Phone/Fax

Practice location:
  • Phone: 636-394-9587
  • Fax: 636-394-9624
Mailing address:
  • Phone: 636-394-9587
  • Fax: 636-394-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVIN POSTOL
Title or Position: OWNER
Credential: DDS
Phone: 636-394-9587