Provider Demographics
NPI:1316016835
Name:K S POWELL DDS PC
Entity Type:Organization
Organization Name:K S POWELL DDS PC
Other - Org Name:THE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SENIOR
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-381-1556
Mailing Address - Street 1:3403 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-1127
Mailing Address - Country:US
Mailing Address - Phone:314-381-1556
Mailing Address - Fax:314-381-4559
Practice Address - Street 1:3403 UNION BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1127
Practice Address - Country:US
Practice Address - Phone:314-381-1556
Practice Address - Fax:314-381-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0119871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11987OtherDENTAL LICENSE