Provider Demographics
NPI:1669832044
Name:DAVID R. KOEPSEL D.D.S., LLC
Entity Type:Organization
Organization Name:DAVID R. KOEPSEL D.D.S., LLC
Other - Org Name:EAST WICHITA DENTIST
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOEPSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-686-7395
Mailing Address - Street 1:8150 E DOUGLAS AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2376
Mailing Address - Country:US
Mailing Address - Phone:316-686-7395
Mailing Address - Fax:316-613-2506
Practice Address - Street 1:8150 E DOUGLAS AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2376
Practice Address - Country:US
Practice Address - Phone:316-686-7395
Practice Address - Fax:316-613-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty