Provider Demographics
NPI:1326123647
Name:SUNSET HILLS DENTAL LLC
Entity Type:Organization
Organization Name:SUNSET HILLS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DEPT REP
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:AHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314842-500-0827
Mailing Address - Street 1:PO BOX 8570
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-0570
Mailing Address - Country:US
Mailing Address - Phone:314-842-5000
Mailing Address - Fax:314-842-7199
Practice Address - Street 1:11810 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-842-5000
Practice Address - Fax:314-842-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty