Provider Demographics
NPI:1871646430
Name:KOPPIKAR, PRABHAKAR MURLIDHAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRABHAKAR
Middle Name:MURLIDHAR
Last Name:KOPPIKAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13847 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1131
Mailing Address - Country:US
Mailing Address - Phone:718-353-7885
Mailing Address - Fax:718-353-7859
Practice Address - Street 1:13847 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1131
Practice Address - Country:US
Practice Address - Phone:718-353-7885
Practice Address - Fax:718-353-7859
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY047445-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice