Provider Demographics
NPI:1972627438
Name:N.RAO KOPURI, BDS.,MS.,PA.
Entity type:Organization
Organization Name:N.RAO KOPURI, BDS.,MS.,PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:N
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KOPURI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,MS
Authorized Official - Phone:321-427-3000
Mailing Address - Street 1:780 E MERRITT ISLAND CSWY
Mailing Address - Street 2:SUITE 6 C
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3562
Mailing Address - Country:US
Mailing Address - Phone:321-453-5833
Mailing Address - Fax:321-453-3633
Practice Address - Street 1:780 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUITE 6 C
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3562
Practice Address - Country:US
Practice Address - Phone:321-453-5833
Practice Address - Fax:321-453-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP000000941341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty