Healthcare Provider Details

I. General information

NPI: 1043237753
Provider Name (Legal Business Name): SAMEET KOPPIKAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 N 32ND ST SUITE B
PHOENIX AZ
85018-4746
US

IV. Provider business mailing address

9501 N 52ND ST
PARADISE VALLEY AZ
85253-1515
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-8200
  • Fax: 602-954-8786
Mailing address:
  • Phone: 480-776-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6333
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6333
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: