Provider Demographics
NPI:1245742204
Name:TOM SOTIROPOULOS METRO DENTAL SLEEP MEDICINE
Entity type:Organization
Organization Name:TOM SOTIROPOULOS METRO DENTAL SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SOTIROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:618-444-3274
Mailing Address - Street 1:1681 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6780
Mailing Address - Country:US
Mailing Address - Phone:618-444-3274
Mailing Address - Fax:
Practice Address - Street 1:5400 WALSH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2859
Practice Address - Country:US
Practice Address - Phone:314-849-5555
Practice Address - Fax:314-675-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017028549261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental