Provider Demographics
NPI:1194367789
Name:ARCH DENTISTRY
Entity Type:Organization
Organization Name:ARCH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONU
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHUVALLIAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-764-5312
Mailing Address - Street 1:807 HAZELWEST DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1748
Mailing Address - Country:US
Mailing Address - Phone:636-489-9330
Mailing Address - Fax:
Practice Address - Street 1:807 HAZELWEST DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1748
Practice Address - Country:US
Practice Address - Phone:636-489-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE