Provider Demographics
NPI:1881680684
Name:POSTOL, KEVIN FERGUSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:FERGUSON
Last Name:POSTOL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 BIG BEND SQUARE SHOP CTR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7618
Mailing Address - Country:US
Mailing Address - Phone:636-394-9587
Mailing Address - Fax:636-394-9624
Practice Address - Street 1:1338 BIG BEND SQUARE SHOP CTR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7618
Practice Address - Country:US
Practice Address - Phone:636-394-9587
Practice Address - Fax:636-394-9624
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0153911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice