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General NPI Number Information
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NPI Number | 1144426214
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Entity Type | Organization
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Legal Business Name | SHERRI POETTKER DMD LLC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3090 WINGHAVEN BLVD
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City | O FALLON
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State | MO
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Zip | 63368
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Country | US
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Telephone | 636-561-0800
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Fax | 636-625-0088
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Provider Business Mailing Address
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Address Line | 3090 WINGHAVEN BLVD
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City | O FALLON
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State | MO
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Zip | 63368
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Country | US
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Telephone | 636-561-0800
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Fax | 636-625-0088
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | MRS. SHERRI LYNN POETTKER
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Credential | DMD
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Telephone | 636-561-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2003000402
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License Number State | MO
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