Provider Demographics
NPI:1275701369
Name:GEOFFREY A. KLOPENSTINE DDS PC
Entity type:Organization
Organization Name:GEOFFREY A. KLOPENSTINE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KLOPENSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-272-6575
Mailing Address - Street 1:51584 US HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-1704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51584 US HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-1704
Practice Address - Country:US
Practice Address - Phone:574-272-6575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009913A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty