Provider Demographics
NPI:1780136838
Name:KURT A. WEISENFELS, DDS, PC
Entity type:Organization
Organization Name:KURT A. WEISENFELS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISENFELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-961-3244
Mailing Address - Street 1:20 W LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2932
Mailing Address - Country:US
Mailing Address - Phone:314-961-3244
Mailing Address - Fax:
Practice Address - Street 1:20 W LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2932
Practice Address - Country:US
Practice Address - Phone:314-961-3244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13075332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies