Healthcare Provider Details

I. General information

NPI: 1295387124
Provider Name (Legal Business Name): KOP ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W DEKALB PIKE STE 301
KING OF PRUSSIA PA
19406-3060
US

IV. Provider business mailing address

600 W DEKALB PIKE STE 301
KING OF PRUSSIA PA
19406-3060
US

V. Phone/Fax

Practice location:
  • Phone: 484-648-7765
  • Fax:
Mailing address:
  • Phone: 484-648-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MEETU R KOHLI
Title or Position: PARTNER
Credential:
Phone: 215-813-2686