Provider Demographics
NPI:1386864387
Name:VOSSMEYER, KATRYNA MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:KATRYNA
Middle Name:MARIE
Last Name:VOSSMEYER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 BIG HORN BASIN CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4818
Mailing Address - Country:US
Mailing Address - Phone:636-458-2922
Mailing Address - Fax:
Practice Address - Street 1:777 S. NEW BALLAS
Practice Address - Street 2:SUITE 310 WEST
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-872-8712
Practice Address - Fax:314-569-9409
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0154231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice