Provider Demographics
NPI:1043237753
Name:KOPPIKAR, SAMEET (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMEET
Middle Name:
Last Name:KOPPIKAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1515
Mailing Address - Country:US
Mailing Address - Phone:480-776-7848
Mailing Address - Fax:
Practice Address - Street 1:4202 N 32ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4746
Practice Address - Country:US
Practice Address - Phone:602-954-8200
Practice Address - Fax:602-954-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD63331223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice