Provider Demographics
NPI:1891922092
Name:KARPOVCK, MARK G (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:KARPOVCK
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 1:101 S US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-4378
Mailing Address - Country:US
Mailing Address - Phone:352-753-1114
Mailing Address - Fax:352-753-9127
Practice Address - Street 1:101 S US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4378
Practice Address - Country:US
Practice Address - Phone:352-753-1114
Practice Address - Fax:352-753-9127
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN121631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU21992OtherBASIC UPIN ( WE ARE NOT MEDICARE PROVIDERS)