Provider Demographics
NPI:1598777815
Name:DEJTIRANUKUL, NUMPOL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NUMPOL
Middle Name:
Last Name:DEJTIRANUKUL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 HUBER PARK COURT
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304
Mailing Address - Country:US
Mailing Address - Phone:636-300-4280
Mailing Address - Fax:
Practice Address - Street 1:530 HUBER PARK COURT
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304
Practice Address - Country:US
Practice Address - Phone:636-300-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001702431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice