Provider Demographics
NPI:1467460006
Name:KUPEC, MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KUPEC
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 1:115 SUNDANCE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7914
Mailing Address - Country:US
Mailing Address - Phone:512-600-7645
Mailing Address - Fax:512-600-7650
Practice Address - Street 1:115 SUNDANCE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7914
Practice Address - Country:US
Practice Address - Phone:512-600-7645
Practice Address - Fax:512-600-7650
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice