Healthcare Provider Details

I. General information

NPI: 1932932779
Provider Name (Legal Business Name): ROSTYSLAV KOPYNETS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12410 N NEBRASKA AVE
TAMPA FL
33612-5352
US

IV. Provider business mailing address

3676 COLLIN DR STE 4
WEST PALM BEACH FL
33406-4718
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-5300
  • Fax:
Mailing address:
  • Phone: 561-440-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: