Healthcare Provider Details

I. General information

NPI: 1326138827
Provider Name (Legal Business Name): MICHAEL PAUL POPERNACK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7776 SR 655 SUITE C
REEDSVILLE PA
17084
US

IV. Provider business mailing address

PO BOX 577 7776 SR 655 SUITE C
REEDSVILLE PA
17084-0577
US

V. Phone/Fax

Practice location:
  • Phone: 717-667-2358
  • Fax:
Mailing address:
  • Phone: 717-667-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS-031199L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: