Healthcare Provider Details

I. General information

NPI: 1891699518
Provider Name (Legal Business Name): SONU MUTHUVALLIAPPAN 4 DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N CENTRAL AVE STE A
EUREKA MO
63025-1850
US

IV. Provider business mailing address

709 THE HAMPTONS LN
CHESTERFIELD MO
63017-5901
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-3384
  • Fax:
Mailing address:
  • Phone: 636-489-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SONU MUTHUVALLIAPPAN
Title or Position: OWNER
Credential: DMD
Phone: 636-489-9330