Healthcare Provider Details

I. General information

NPI: 1992921993
Provider Name (Legal Business Name): ARTHUR WARREN KUPPERMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 VAN COTT RD
DEER PARK NY
11729-6519
US

IV. Provider business mailing address

18 BROOK LN
GLEN HEAD NY
11545-3136
US

V. Phone/Fax

Practice location:
  • Phone: 631-242-8388
  • Fax: 631-242-8375
Mailing address:
  • Phone: 516-626-3465
  • Fax: 516-626-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number030644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: