Healthcare Provider Details

I. General information

NPI: 1144672254
Provider Name (Legal Business Name): KIRSTEN KARKOW DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 STATE ST
EAST SAINT LOUIS IL
62205-2325
US

IV. Provider business mailing address

2608 STATE ST
EAST SAINT LOUIS IL
62205-2325
US

V. Phone/Fax

Practice location:
  • Phone: 618-857-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number09321
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021.003072
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: