Provider Demographics
NPI:1467035329
Name:KOPECKY, EVAN M (DDS)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:M
Last Name:KOPECKY
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 1:95-720 LANIKUHANA AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2987
Mailing Address - Country:US
Mailing Address - Phone:808-748-4972
Mailing Address - Fax:
Practice Address - Street 1:95-720 LANIKUHANA AVE STE 270
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2987
Practice Address - Country:US
Practice Address - Phone:808-748-4972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-29771223G0001X
WI29771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice