Healthcare Provider Details

I. General information

NPI: 1558018002
Provider Name (Legal Business Name): KARLA KOPNISKY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W. OAK ST
OAK CREEK CO
80467-8046
US

IV. Provider business mailing address

PO BOX 743
OAK CREEK CO
80467-0743
US

V. Phone/Fax

Practice location:
  • Phone: 330-414-6623
  • Fax:
Mailing address:
  • Phone: 330-414-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: