MEDICARE: KOPEMAK DENTAL SPECIALISTS, PLLC

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	27210	TX

General Provider Information

NPI Number	:	1841641669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOPEMAK DENTAL SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	444 FOREST SQ
Second Line	:	SUITE A
City	:	LONGVIEW
State	:	TX
Zip	:	75605-4463
Country	:	US
Telephone Number	:	903-758-3329
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 FOREST SQ
Second Line	:	SUITE A
City	:	LONGVIEW
State	:	TX
Zip	:	75605-4463
Country	:	US
Telephone Number	:	903-758-3329
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. ALEJANDRO KOVACS
Credential	:	DDA, MS, FACP, DICOI
Telephone Number	:	612-817-8115

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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