Provider Demographics
NPI:1326138827
Name:POPERNACK, MICHAEL PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:POPERNACK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:7776 SR 655 SUITE C
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-0577
Mailing Address - Country:US
Mailing Address - Phone:717-667-2358
Mailing Address - Fax:
Practice Address - Street 1:7776 SR 655
Practice Address - Street 2:SUITE C
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084
Practice Address - Country:US
Practice Address - Phone:717-667-2358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-031199L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS-031199LOtherDENTAL LICENSE