Provider Demographics
NPI:1629099841
Name:SOPOROWSKI, NANCY JO (DMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY JO
Middle Name:
Last Name:SOPOROWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3920
Mailing Address - Country:US
Mailing Address - Phone:781-455-6546
Mailing Address - Fax:
Practice Address - Street 1:230 POND ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4323
Practice Address - Country:US
Practice Address - Phone:508-653-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry