Healthcare Provider Details

I. General information

NPI: 1235354762
Provider Name (Legal Business Name): HAROLD JOE KOPPEL D.D.S.,M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FILES RD
HOT SPRINGS AR
71913-6914
US

IV. Provider business mailing address

136 FILES RD
HOT SPRINGS AR
71913-6914
US

V. Phone/Fax

Practice location:
  • Phone: 501-525-3238
  • Fax: 501-525-3952
Mailing address:
  • Phone: 501-525-3238
  • Fax: 501-525-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1780
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: