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General NPI Number Information
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NPI Number | 1215509476
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Entity Type | Individual
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Provider Name | CARLY KOUTROPOULOS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | GRUBER RD
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone | 910-396-1572
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Fax |
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Provider Business Mailing Address
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Address Line | 1423 MICAHS WAY N
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City | SPRING LAKE
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State | NC
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Zip | 28390-2869
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Country | US
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Telephone | 219-713-5637
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12013686A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12013686A
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License Number State | IN
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