Provider Demographics
NPI:1881653574
Name:SOPIWNIK, CHRISTINA (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SOPIWNIK
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 1:7665 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54847-4690
Mailing Address - Country:US
Mailing Address - Phone:888-834-4551
Mailing Address - Fax:715-372-5067
Practice Address - Street 1:719 MAIN ST E
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1918
Practice Address - Country:US
Practice Address - Phone:888-834-4551
Practice Address - Fax:715-685-2202
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA11781223G0001X
WI6336-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice