MEDICARE: KOPPELMAN DENTAL

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	261QD0000X	Dental Clinic/Center	035031	NY

General Provider Information

NPI Number	:	1720409865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOPPELMAN DENTAL

Provider Business Mailing Address
First Line	:	7 W 45TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-4905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 W 45TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-4905
Country	:	US
Telephone Number	:	212-382-3782
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	PAUL KOPPELMAN
Credential	:
Telephone Number	:	212-382-3782

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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Directions to “KOPPELMAN DENTAL ” Practice Location

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