Provider Demographics
NPI:1730735283
Name:KOP DENTAL CARE
Entity type:Organization
Organization Name:KOP DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZZOULI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:484-704-7670
Mailing Address - Street 1:600 W DEKALB PIKE STE 302
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3060
Mailing Address - Country:US
Mailing Address - Phone:484-704-7670
Mailing Address - Fax:
Practice Address - Street 1:600 W DEKALB PIKE STE 302
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3060
Practice Address - Country:US
Practice Address - Phone:484-704-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty