Provider Demographics
NPI:1609284579
Name:KOPECKY, BRITTANY (DDS)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:KOPECKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-3587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5710 WATAUGA RD
Practice Address - Street 2:100
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3022
Practice Address - Country:US
Practice Address - Phone:817-281-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX30195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist