Healthcare Provider Details

I. General information

NPI: 1881653574
Provider Name (Legal Business Name): CHRISTINA SOPIWNIK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 MAIN ST E
ASHLAND WI
54806-1918
US

IV. Provider business mailing address

7665 US HIGHWAY 2
IRON RIVER WI
54847-4690
US

V. Phone/Fax

Practice location:
  • Phone: 888-834-4551
  • Fax: 715-685-2202
Mailing address:
  • Phone: 888-834-4551
  • Fax: 715-372-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6336-015
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberAA1178
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: