Provider Demographics
NPI:1427656248
Name:KOPIT DENTAL CARE, PA
Entity type:Organization
Organization Name:KOPIT DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PESIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-378-2595
Mailing Address - Street 1:3420 WORTHINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7020
Mailing Address - Country:US
Mailing Address - Phone:410-274-4044
Mailing Address - Fax:
Practice Address - Street 1:3420 WORTHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7020
Practice Address - Country:US
Practice Address - Phone:301-874-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty