MEDICARE: DR. BRYAN N. KOOPMANN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14080	TX

General Provider Information

NPI Number	:	1073592192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN N. KOOPMANN DDS

Provider Business Mailing Address
First Line	:	3901 S LAMAR BLVD
Second Line	:	SUITE 400
City	:	AUSTIN
State	:	TX
Zip	:	78704-8801
Country	:	US
Telephone Number	:	512-442-7897
Fax Number	:	512-448-2343

Provider Business Practice Location Address
First Line	:	3901 S LAMAR BLVD
Second Line	:	SUITE 400
City	:	AUSTIN
State	:	TX
Zip	:	78704-8801
Country	:	US
Telephone Number	:	512-442-7897
Fax Number	:	512-448-2343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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