Healthcare Provider Details

I. General information

NPI: 1023138534
Provider Name (Legal Business Name): KARSON A. KUPIEC D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 SAXONY PL STE 103
ENCINITAS CA
92024-2797
US

IV. Provider business mailing address

711 AMPHITHEATRE DR
DEL MAR CA
92014-2615
US

V. Phone/Fax

Practice location:
  • Phone: 760-634-4800
  • Fax: 760-634-4870
Mailing address:
  • Phone: 858-720-9096
  • Fax: 760-634-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number44328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: