Healthcare Provider Details

I. General information

NPI: 1821268871
Provider Name (Legal Business Name): DARREL ELGIN KNEUPPER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 W CHEYENNE RD
COLORADO SPRINGS CO
80906-2460
US

IV. Provider business mailing address

1106 WEST CHEYENNE RAOD
COLORADO SPRINGS CO
80906-2460
US

V. Phone/Fax

Practice location:
  • Phone: 719-963-2737
  • Fax: 719-634-6233
Mailing address:
  • Phone: 719-963-2737
  • Fax: 719-634-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number234
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: