Provider Demographics
NPI:1134529910
Name:ROBERT P. SOPKO, DDS, PA
Entity type:Organization
Organization Name:ROBERT P. SOPKO, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOPKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-819-9289
Mailing Address - Street 1:3708 FORESTVIEW RD
Mailing Address - Street 2:STE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8042
Mailing Address - Country:US
Mailing Address - Phone:919-819-9289
Mailing Address - Fax:919-747-4334
Practice Address - Street 1:3708 FORESTVIEW RD
Practice Address - Street 2:STE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8042
Practice Address - Country:US
Practice Address - Phone:919-819-9289
Practice Address - Fax:919-747-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1223E0200XOtherENDO