Provider Demographics
NPI:1558442772
Name:KOPACZ, JENNIFER LIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LIM
Last Name:KOPACZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LIM
Other - Last Name:KENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:980 WESTFALL RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2605
Mailing Address - Country:US
Mailing Address - Phone:585-442-6600
Mailing Address - Fax:585-442-9719
Practice Address - Street 1:980 WESTFALL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2605
Practice Address - Country:US
Practice Address - Phone:585-442-6600
Practice Address - Fax:585-442-9719
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048305-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice