Provider Demographics
NPI:1760530562
Name:KOYFMAN, KLEOPATRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KLEOPATRA
Middle Name:
Last Name:KOYFMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 OVERLAND PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-6122
Mailing Address - Country:US
Mailing Address - Phone:314-428-5400
Mailing Address - Fax:
Practice Address - Street 1:9010 OVERLAND PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-6122
Practice Address - Country:US
Practice Address - Phone:314-428-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0157771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice