1598034894 NPI number — KLOPENSTINE FAMILY DENTISTRY PC

Table of content: DANIEL WISE MCNAUGHTON VI (NPI 1275344962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598034894 NPI number — KLOPENSTINE FAMILY DENTISTRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLOPENSTINE FAMILY DENTISTRY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598034894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52120 STATE ROAD 933
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46637-3846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52120 STATE ROAD 933
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46637-3846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-217-8170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KLOPENSTINE
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/DENTIST OWNER
Authorized Official Telephone Number:
574-217-8170

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  12009913A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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