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General NPI Number Information
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NPI Number | 1518047885
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Entity Type | Organization
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Legal Business Name | KOPP & LUCKETT FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8009 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40291-3439
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Country | US
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Telephone | 502-231-6474
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Fax | 502-231-6461
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Provider Business Mailing Address
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Address Line | 8009 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40291-3439
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Country | US
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Telephone | 502-231-6474
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Fax | 502-231-6461
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Authorized Official
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Title or Position | CO-OWNER
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Name | BRIAN MATTHEW KOPP
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Credential | D.M.D.
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Telephone | 502-231-6474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7365
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License Number State | KY
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