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General NPI Number Information
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NPI Number | 1316016835
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Entity Type | Organization
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Legal Business Name | K S POWELL DDS PC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3403 UNION BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1127
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Country | US
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Telephone | 314-381-1556
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Fax | 314-381-4559
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Provider Business Mailing Address
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Address Line | 3403 UNION BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1127
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Country | US
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Telephone | 314-381-1556
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Fax | 314-381-4559
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH SENIOR POWELL II
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Credential | DDS
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Telephone | 314-381-1556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 011987
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License Number State | MO
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