Provider Demographics
NPI:1801168505
Name:METRO DENTAL SLEEP MEDICINE, LLC
Entity type:Organization
Organization Name:METRO DENTAL SLEEP MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SABA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-740-1395
Mailing Address - Street 1:11222 TESSON FERRY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6963
Mailing Address - Country:US
Mailing Address - Phone:314-849-5555
Mailing Address - Fax:314-675-9955
Practice Address - Street 1:11222 TESSON FERRY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6963
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:2012-01-27
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty