Provider Demographics
NPI:1548646219
Name:KUPPERMAN, NATHAN ADAM II (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ADAM
Last Name:KUPPERMAN
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5518
Mailing Address - Country:US
Mailing Address - Phone:850-222-2446
Mailing Address - Fax:850-385-3700
Practice Address - Street 1:221 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5518
Practice Address - Country:US
Practice Address - Phone:850-222-2446
Practice Address - Fax:850-385-3700
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist