Provider Demographics
NPI:1306933171
Name:POETTKER, SHERRI LIN (DMD)
Entity type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:LIN
Last Name:POETTKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:SHERRI
Other - Middle Name:LIN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3090 WINGHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368
Mailing Address - Country:US
Mailing Address - Phone:636-561-0800
Mailing Address - Fax:636-625-0088
Practice Address - Street 1:3090 WINGHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-561-0800
Practice Address - Fax:636-625-0088
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003000402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist