Provider Demographics
NPI:1699836841
Name:KOPCZYK, LARRY RAYMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RAYMOND
Last Name:KOPCZYK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 STERLINGTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3937
Mailing Address - Country:US
Mailing Address - Phone:859-273-5556
Mailing Address - Fax:
Practice Address - Street 1:2335 STERLINGTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3937
Practice Address - Country:US
Practice Address - Phone:859-273-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice