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NPI Code Detail

MEDICARE: MONTICELLO SLEEP DENTISTRY LLC

MEDICARE: MONTICELLO SLEEP DENTISTRY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1053273482
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONTICELLO SLEEP DENTISTRY LLC
Provider Business Mailing Address
First Line : 530 HUBER PARK CT STE 201
Second Line :
City : WELDON SPRING
State : MO
Zip : 63304-8621
Country : US
Telephone Number : 636-244-2080
Fax Number :
Provider Business Practice Location Address
First Line : 530 HUBER PARK CT STE 201
Second Line :
City : WELDON SPRING
State : MO
Zip : 63304-8621
Country : US
Telephone Number : 636-244-2080
Fax Number :
Authorized Official
Title or Position : SOLE MBR/DENTIST
Name : NUMPOL DEJTIRANUKUL
Credential : DMD
Telephone Number : 636-299-7737
Provider Enumeration Date : 11/24/2025
Last Update Date : 11/24/2025

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Directions to “MONTICELLO SLEEP DENTISTRY LLC ” Practice Location

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