NUMPOL DEJTIRANUKUL DMD LLC (NPI# 1043479215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043479215 |
| Entity Type | Organization |
| Organization Name | NUMPOL DEJTIRANUKUL DMD LLC |
| Practice Address |
4122 Keaton Crossing Blvd Suite 101 O Fallon MO 63368-8218 |
| Practice Telephone | 6363004280 |
| Mailing Telephone | 6363004280 |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |
| Authorized Official Name | DR. NUMPOL DEJTIRANUKUL (SINGLE MEMBER) |
| Authorized Official Telephone | 6363004280 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
2000170243 | MO | Dental Providers |
| Street Address |
4122 KEATON CROSSING BLVD SUITE 101 |
| City | O FALLON |
| State | MO |
| Zip Code | 63368-8218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598777815 | Numpol Dejtiranukul | Dentist | 4122 Keaton Crossing Blvd, Suite 101, O Fallon, MO 63368-8218 | 2006-08-13 |
| 1609384205 | Elizabeth Christy | Nurse Practitioner | 4122 Keaton Crossing Blvd, O Fallon, MO 63368-8218 | 2018-01-17 |
| 1700328523 | Emily Maire Boyle | Nurse Practitioner | 4122 Keaton Crossing Blvd, O Fallon, MO 63368-8218 | 2016-11-10 |
| 1104278068 | Back Together Chiropractic, LLC | Chiropractor | 4122 Keaton Crossing Blvd, Suite 105, O Fallon, MO 63368-8218 | 2016-07-04 |
| 1699135434 | Laura Christine Thomas | Nurse Practitioner | 4122 Keaton Crossing Blvd, Suite 102, O Fallon, MO 63368-8218 | 2016-03-04 |
| 1326410036 | Lakendria Hawkins | Chiropractor | 4122 Keaton Crossing Blvd, Ste 105, O Fallon, MO 63368-8219 | 2015-10-21 |
| 1841544251 | Elpis Pain Management Center LLC | Anesthesiology | 4122 Keaton Crossing Blvd, Suite 102, O Fallon, MO 63368-8218 | 2012-11-07 |
| 1083729941 | Vivek K Manchanda | Anesthesiology | 4122 Keaton Crossing Blvd, Suite 102, O Fallon, MO 63368-8218 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720329 | Come As You Are Counseling LLC | Counselor | 1001 Boardwalk Springs Place, Suite 111, O Fallon, MO 63368 | 2020-11-04 |
| 1770124802 | Lisa N. Greer | Technician | 6911 Brassel Dr., Ofallon, MO 63368 | 2019-09-30 |
| 1770145716 | Halie Faye Gulley | Dentist | 3009 Hwy K, O'fallon, MO 63368 | 2019-06-29 |
| 1972079556 | Erin Corsi Fraundorf | Dentist | 3009 State Hwy K, O'fallon, MO 63368 | 2018-10-22 |
| 1427579960 | Air Evac Ems, Inc. | Ambulance | 1001 Boardwalk Springs Pl Ste 250, O Fallon, MO 63368 | 2017-07-06 |
| 1528507472 | Washeck Manual Therapy LLC | Clinic/Center | 3074 Winghaven Blvd, O'fallon, MO 63368 | 2017-02-13 |
| 1639618457 | Brittany Hogan | Physical Therapist | 7412 South Outer 364, Suite B, Dardenne Prairie, MO 63368 | 2017-02-13 |
| 1124561469 | Cardinal Home Care LLC | Home Health | 18 Convent Garden Ct, O'fallon, MO 63368 | 2016-11-18 |
| 1336509272 | Sarah Marie Mudd | Counselor | 1654 Bryan Road, O'fallon, MO 63368 | 2016-03-04 |
| 1588023956 | Price-bourisaw Family Chiropractic | Chiropractor | 2917 State Highway K, O Fallon, MO 63368 | 2016-02-15 |
| Find all providers in zip 63368 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235544024 | Anne Bollmeier | Dentist | 2010 W Highway 50, O Fallon, IL 62269-1628 | 2014-06-30 |
| 1356632350 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 3445 Pheasant Meadow Dr, O Fallon, MO 63368-7324 | 2011-04-25 |
| 1518134238 | O'fallon Dental Partnership, Barry Brace, Dmd and Associates, LLC | Dentist | 2940 Highway K, O Fallon, MO 63368-7861 | 2008-05-12 |
| 1033383997 | Sherryl Schoening Dds II PC | Dentist | 9210 Phoenix Village Pkwy, O Fallon, MO 63368-4779 | 2008-04-22 |
| 1912109646 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 3011 Winghaven Blvd, O Fallon, MO 63368-3600 | 2007-06-04 |
| 1851412985 | Dennis L Schulze | Dentist | 4001 Highway K, O Fallon, MO 63368-8136 | 2007-04-03 |
| 1700932464 | Thomas D. Jordan, Dds, PC | Dentist | 346 Fort Zumwalt Sq, O Fallon, MO 63366-3065 | 2007-01-26 |
| 1831252519 | Frank J Meier | Dentist | 2726 Highway K, O Fallon, MO 63368-7884 | 2006-12-18 |
| 1720146525 | William Paul Burns Sr. | Dentist | 2315 Technology Dr, Suite 101, O Fallon, MO 63368-7370 | 2006-12-05 |
| 1750453429 | Jennifer Wilson Hershey | Dentist | 8803 Veterans Memorial Pkwy, O Fallon, MO 63366-7540 | 2006-11-15 |
| Find all providers in O FALLON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.