Healthcare Provider Details

I. General information

NPI: 1942129838
Provider Name (Legal Business Name): STL MID COUNTY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 HAWK RIDGE CIR
LAKE ST LOUIS MO
63367-1824
US

IV. Provider business mailing address

28 HAWK RIDGE CIR
LAKE ST LOUIS MO
63367-1824
US

V. Phone/Fax

Practice location:
  • Phone: 636-333-6150
  • Fax: 636-333-9915
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN LANDGRAF
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 314-471-1949