Provider Demographics
NPI:1356320501
Name:VAL KOLPAKOV DDS, MD, PHD, PC
Entity Type:Organization
Organization Name:VAL KOLPAKOV DDS, MD, PHD, PC
Other - Org Name:DENTURE CARE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLPAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-754-8150
Mailing Address - Street 1:1227 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4729
Mailing Address - Country:US
Mailing Address - Phone:989-754-8150
Mailing Address - Fax:989-754-8152
Practice Address - Street 1:1227 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4729
Practice Address - Country:US
Practice Address - Phone:989-754-8150
Practice Address - Fax:989-754-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-14
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124378124Medicaid