Healthcare Provider Details

I. General information

NPI: 1760530562
Provider Name (Legal Business Name): KLEOPATRA KOYFMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 OVERLAND PLZ
SAINT LOUIS MO
63114-6122
US

IV. Provider business mailing address

9010 OVERLAND PLZ
SAINT LOUIS MO
63114-6122
US

V. Phone/Fax

Practice location:
  • Phone: 314-428-5400
  • Fax:
Mailing address:
  • Phone: 314-428-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015777
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: