Provider Demographics
NPI:1356894257
Name:S.A. KOPLON DMD PC
Entity type:Organization
Organization Name:S.A. KOPLON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOPLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-699-2551
Mailing Address - Street 1:8125 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-2227
Mailing Address - Country:US
Mailing Address - Phone:205-699-2551
Mailing Address - Fax:205-699-5653
Practice Address - Street 1:8125 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-2227
Practice Address - Country:US
Practice Address - Phone:205-699-2551
Practice Address - Fax:205-699-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty