Healthcare Provider Details

I. General information

NPI: 1396095287
Provider Name (Legal Business Name): MOLLY ELIZABETH KOPACZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 ERINDALE DR STE 200
COLORADO SPRINGS CO
80918-8902
US

IV. Provider business mailing address

5745 ERINDALE DR STE 200
COLORADO SPRINGS CO
80918-8902
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-7665
  • Fax:
Mailing address:
  • Phone: 719-599-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6875
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDEN.00205836
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: