Provider Demographics
NPI:1689813347
Name:JAMES A. KOPFENSTEINER, DDS LLC
Entity Type:Organization
Organization Name:JAMES A. KOPFENSTEINER, DDS LLC
Other - Org Name:ST. CHARLES COUNTY PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOPFENSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-928-8790
Mailing Address - Street 1:303 JUNGERMANN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5366
Mailing Address - Country:US
Mailing Address - Phone:636-928-8790
Mailing Address - Fax:636-928-1291
Practice Address - Street 1:303 JUNGERMANN RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5366
Practice Address - Country:US
Practice Address - Phone:636-928-8790
Practice Address - Fax:636-928-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0150571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty