Provider Demographics
NPI:1427275544
Name:KOEPPEL, IRA D (DDS)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:D
Last Name:KOEPPEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 GNARLED HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1975
Mailing Address - Country:US
Mailing Address - Phone:631-689-9777
Mailing Address - Fax:631-689-2108
Practice Address - Street 1:126 GNARLED HOLLOW RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1975
Practice Address - Country:US
Practice Address - Phone:631-689-9777
Practice Address - Fax:631-689-2108
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038668-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice