Provider Demographics
NPI:1932694585
Name:KOTSOPEY, PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:KOTSOPEY
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 1:1 BETSY CT
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-9739
Mailing Address - Country:US
Mailing Address - Phone:609-540-2159
Mailing Address - Fax:
Practice Address - Street 1:1100 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1410
Practice Address - Country:US
Practice Address - Phone:609-393-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027165001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice