Provider Demographics
NPI:1134612070
Name:KOPEC, EMILY SUZANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:SUZANNE
Last Name:KOPEC
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BUCK ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-9419
Mailing Address - Country:US
Mailing Address - Phone:319-360-1262
Mailing Address - Fax:
Practice Address - Street 1:4150 EDGEWOOD RD NE STE 150
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7107
Practice Address - Country:US
Practice Address - Phone:319-360-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-095681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice