Provider Demographics
NPI:1851873616
Name:KOPP, LAUREN (DDS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KOPP
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 1:85 ADAMS ST APT 17B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1409
Mailing Address - Country:US
Mailing Address - Phone:425-923-3008
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7206
Practice Address - Country:US
Practice Address - Phone:212-579-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608912621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice