Provider Demographics
NPI:1902815798
Name:KOROPP, MICHAEL LEO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEO
Last Name:KOROPP
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2601 BONIFACE PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3106
Mailing Address - Country:US
Mailing Address - Phone:907-338-8999
Mailing Address - Fax:907-337-5715
Practice Address - Street 1:2700 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1603
Practice Address - Country:US
Practice Address - Phone:907-248-8999
Practice Address - Fax:907-245-0423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK5351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics