Provider Demographics
NPI:1861403438
Name:SOPKOWICZ, LINDA S (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:SOPKOWICZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:GADOW SOPKOWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1201 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-334-2959
Mailing Address - Fax:262-334-2088
Practice Address - Street 1:1201 OAK STREET
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-334-2959
Practice Address - Fax:262-334-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWIS3478015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist