Provider Demographics
NPI:1417095738
Name:SOPEL, GREGORY ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROBERT
Last Name:SOPEL
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 8450
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657
Mailing Address - Country:US
Mailing Address - Phone:830-598-5474
Mailing Address - Fax:830-596-9054
Practice Address - Street 1:420A HI CIRCLE SOUTH
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657
Practice Address - Country:US
Practice Address - Phone:830-598-5474
Practice Address - Fax:830-596-9054
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist