Provider Demographics
NPI:1477656742
Name:KANIVE, COURTNEY BETH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:BETH
Last Name:KANIVE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7717
Mailing Address - Country:US
Mailing Address - Phone:636-399-2387
Mailing Address - Fax:
Practice Address - Street 1:1006 SCHROEDER CREEK BLVD.
Practice Address - Street 2:SUITE 1006
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-327-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040157711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics