Healthcare Provider Details

I. General information

NPI: 1659449775
Provider Name (Legal Business Name): KEVIN C KOPP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 N YORK RD
ELMHURST IL
60126
US

IV. Provider business mailing address

188 N YORK RD
ELMHURST IL
60126
US

V. Phone/Fax

Practice location:
  • Phone: 630-941-8398
  • Fax: 630-941-8408
Mailing address:
  • Phone: 630-941-8398
  • Fax: 630-941-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number190196599
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: