Provider Demographics
NPI:1124489018
Name:KOPERLY INC
Entity type:Organization
Organization Name:KOPERLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOPERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, BDS
Authorized Official - Phone:832-436-8277
Mailing Address - Street 1:27 MAIN ST
Mailing Address - Street 2:UNIT 104
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8109
Mailing Address - Country:US
Mailing Address - Phone:832-436-8277
Mailing Address - Fax:
Practice Address - Street 1:27 MAIN ST
Practice Address - Street 2:UNIT 104
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8109
Practice Address - Country:US
Practice Address - Phone:832-436-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00202418261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental