=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407076953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARRIN CUPO DMD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1670 N UNIVERSITY DRIVE SUITE B
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-346-8108
-----------------------------------------------------
Fax | 954-346-0057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1670 N UNIVERSITY DRIVE SUITE B
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-346-8108
-----------------------------------------------------
Fax | 954-346-0057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DARRIN CUPO
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 954-346-8108
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 13006
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------