Provider Demographics
NPI:1649575531
Name:KLOSTERMYER, URSULA (DDS PHD)
Entity Type:Individual
Prefix:DR
First Name:URSULA
Middle Name:
Last Name:KLOSTERMYER
Suffix:
Gender:F
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 GLEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3782
Mailing Address - Country:US
Mailing Address - Phone:804-282-7260
Mailing Address - Fax:804-282-7262
Practice Address - Street 1:7204 GLEN FOREST DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3782
Practice Address - Country:US
Practice Address - Phone:804-282-7260
Practice Address - Fax:804-282-7262
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132971223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics