Healthcare Provider Details

I. General information

NPI: 1780136838
Provider Name (Legal Business Name): KURT A. WEISENFELS, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W LOCKWOOD AVE
SAINT LOUIS MO
63119-2932
US

IV. Provider business mailing address

20 W LOCKWOOD AVE
SAINT LOUIS MO
63119-2932
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-3244
  • Fax:
Mailing address:
  • Phone: 314-961-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number13075
License Number StateMO

VIII. Authorized Official

Name: DR. KURT A. WEISENFELS
Title or Position: DENTIST
Credential:
Phone: 314-961-3244