=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659169944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAM COPPENBARGER DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2025
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S TOWNE EAST MALL DR
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67207-1069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-685-5321
-----------------------------------------------------
Fax | 316-651-5723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 S TOWNE EAST MALL DR
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67207-1069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-685-5321
-----------------------------------------------------
Fax | 316-651-5723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ADAM COPPENBARGER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 316-308-5749
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------