Provider Demographics
NPI:1073592192
Name:KOOPMANN, BRYAN N (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:N
Last Name:KOOPMANN
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 1:3901 S LAMAR BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8801
Mailing Address - Country:US
Mailing Address - Phone:512-442-7897
Mailing Address - Fax:512-448-2343
Practice Address - Street 1:3901 S LAMAR BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8801
Practice Address - Country:US
Practice Address - Phone:512-442-7897
Practice Address - Fax:512-448-2343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice