Individual
OLEG PROKOPENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
621 S NEW BALLAS RD STE 16A, SAINT LOUIS, MO 63141-8239
(314) 251-6725
(314) 251-6726
Mailing address
621 S NEW BALLAS RD STE 16A, SAINT LOUIS, MO 63141-8239
(314) 251-6725
(314) 251-6726
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2024020971
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2018
Last updated
06/26/2024
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