Provider Demographics
NPI:1780983668
Name:KOPCZA, KAROLYN CHRISTINE (DDS)
Entity type:Individual
Prefix:
First Name:KAROLYN
Middle Name:CHRISTINE
Last Name:KOPCZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E 96TH ST APT 22O
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6211
Mailing Address - Country:US
Mailing Address - Phone:570-762-7069
Mailing Address - Fax:
Practice Address - Street 1:169 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2907
Practice Address - Country:US
Practice Address - Phone:914-965-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY056639-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program