Healthcare Provider Details

I. General information

NPI: 1407923907
Provider Name (Legal Business Name): JAY JOSEPH KOPF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 41ST ST SUITE 404
MIAMI BEACH FL
33140-3516
US

IV. Provider business mailing address

400 W 41ST ST SUITE 404
MIAMI BEACH FL
33140-3516
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-1714
  • Fax: 305-535-8190
Mailing address:
  • Phone: 305-535-1714
  • Fax: 305-535-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 13892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: