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General NPI Number Information
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NPI Number | 1063848224
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Entity Type | Organization
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Legal Business Name | SLEEP RIGHT DENTAL LLC
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 4390 GREEN ASH DR
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City | EARTH CITY
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State | MO
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Zip | 63045-1219
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Country | US
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Telephone | 314-537-6815
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Fax |
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Provider Business Mailing Address
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Address Line | 4390 GREEN ASH DR
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City | EARTH CITY
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State | MO
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Zip | 63045-1219
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Country | US
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Telephone | 314-537-6815
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN JOSEPH STOCK
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Credential | DDS
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Telephone | 314-537-6815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2013017372
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2013017372
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 2013017372
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License Number State | MO
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