Healthcare Provider Details

I. General information

NPI: 1013423581
Provider Name (Legal Business Name): YVONNE B KINKOPF DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 GRAHAM RD
STOW OH
44224-3643
US

IV. Provider business mailing address

3102 GRAHAM RD
STOW OH
44224-3643
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-6830
  • Fax:
Mailing address:
  • Phone: 330-673-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YVONNE BILO KINKOPF
Title or Position: PRESIDENT
Credential: DDS
Phone: 330-673-6830