Provider Demographics
NPI:1972682458
Name:KOPPEL, ROGER LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEWIS
Last Name:KOPPEL
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 1:1760 SOLANO AVE
Mailing Address - Street 2:#309
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2218
Mailing Address - Country:US
Mailing Address - Phone:510-527-9564
Mailing Address - Fax:510-527-9569
Practice Address - Street 1:1760 SOLANO AVE
Practice Address - Street 2:#309
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2218
Practice Address - Country:US
Practice Address - Phone:510-527-9564
Practice Address - Fax:510-527-9569
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ0291611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice