Healthcare Provider Details

I. General information

NPI: 1245914555
Provider Name (Legal Business Name): OLIVIA SACOPULOS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 US HIGHWAY 6
PORTAGE IN
46368-5057
US

IV. Provider business mailing address

6210 US HIGHWAY 6
PORTAGE IN
46368-5057
US

V. Phone/Fax

Practice location:
  • Phone: 219-706-2213
  • Fax:
Mailing address:
  • Phone: 219-706-2213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014913A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: