MEDICARE: DR. ELENA ALONA KOPKO 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	DN16979	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215009543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELENA ALONA KOPKO DDS

Provider Business Mailing Address
First Line	:	7100 PLANTATION RD
Second Line	:	SUITE #9
City	:	PENSACOLA
State	:	FL
Zip	:	32504-4206
Country	:	US
Telephone Number	:	850-477-2355
Fax Number	:	850-477-2209

Provider Business Practice Location Address
First Line	:	7100 PLANTATION RD
Second Line	:	SUITE #9
City	:	PENSACOLA
State	:	FL
Zip	:	32504-4206
Country	:	US
Telephone Number	:	850-477-2355
Fax Number	:	850-477-2209

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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