Provider Demographics
NPI:1730624115
Name:SPRINGFIELD DENTISTRY
Entity type:Organization
Organization Name:SPRINGFIELD DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOPENSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-548-0005
Mailing Address - Street 1:452 MERCANTILE PLACE
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715
Mailing Address - Country:US
Mailing Address - Phone:803-548-0005
Mailing Address - Fax:
Practice Address - Street 1:452 MERCANTILE PLACE
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715
Practice Address - Country:US
Practice Address - Phone:803-548-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK KLOPENSTINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1223G0001XMedicaid