Provider Demographics
NPI:1710062153
Name:KOUROUPAS, KATHY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:KOUROUPAS
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 1:475 5TH AVE
Mailing Address - Street 2:STE 514
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-779-0125
Mailing Address - Fax:212-779-0127
Practice Address - Street 1:475 5TH AVE
Practice Address - Street 2:STE 514
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-779-0125
Practice Address - Fax:212-779-0127
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0461541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist