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General NPI Number Information
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NPI Number | 1821944240
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Entity Type | Organization
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Legal Business Name | POUREDOUT DENTAL GROUP LLC
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 10777 SUNSET OFFICE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1052
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Country | US
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Telephone | 573-261-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 10777 SUNSET OFFICE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1052
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Country | US
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Telephone | 573-261-4399
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TIMBERLEE MINOR
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Credential |
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Telephone | 573-205-2230
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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 |
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License Number State |
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