MEDICARE: DR. KIRSTEN KARKOW DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	09321	IA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	021.003072	IL

General Provider Information

NPI Number	:	1144672254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTEN KARKOW DDS, MS

Provider Business Mailing Address
First Line	:	2608 STATE ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62205-2325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 STATE ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62205-2325
Country	:	US
Telephone Number	:	618-857-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	01/21/2021

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