Provider Demographics
NPI:1194017640
Name:ANA SCOPU DDS PC
Entity Type:Organization
Organization Name:ANA SCOPU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOPU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-821-7432
Mailing Address - Street 1:62-22 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-821-7432
Mailing Address - Fax:718-821-1353
Practice Address - Street 1:62-22 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-821-7432
Practice Address - Fax:718-821-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty