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NPI Code Detail

MEDICARE: KATHERINE BOXDORFER DDS

MEDICARE: KATHERINE BOXDORFER DDS
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
1390200000XStudent in an Organized Health Care Education/Training Program2022018729MO
21223G0001XGeneral Practice Dentistry2022018729MO

General Provider Information

NPI Number : 1679202865
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE BOXDORFER DDS
Provider Business Mailing Address
First Line : 93 RICHARDET ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-2245
Country : US
Telephone Number : 573-513-1265
Fax Number :
Provider Business Practice Location Address
First Line : 22 S WEST ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-2547
Country : US
Telephone Number : 573-547-6691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2022
Last Update Date : 06/06/2022

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Directions to “ KATHERINE BOXDORFER DDS” Practice Location

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