Provider Demographics
NPI:1073780367
Name:MARK KUPEC, D.D.S., P.C.
Entity type:Organization
Organization Name:MARK KUPEC, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-930-7645
Mailing Address - Street 1:7600 HIGHWAY 29 W
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6937
Mailing Address - Country:US
Mailing Address - Phone:512-930-7645
Mailing Address - Fax:
Practice Address - Street 1:7600 HIGHWAY 29 W
Practice Address - Street 2:SUITE 9
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6937
Practice Address - Country:US
Practice Address - Phone:512-930-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty