Provider Demographics
NPI:1255900338
Name:KOPELIOVICH, DAN CHAIM (MD DMD)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:CHAIM
Last Name:KOPELIOVICH
Suffix:
Gender:M
Credentials:MD DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MARYLAND, SCHOOL OF DENTISTRY, MAXI
Mailing Address - Street 2:650 W BALTIMORE ST. #1216
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-706-3964
Mailing Address - Fax:
Practice Address - Street 1:UMMC, ORAL & MAXILLOFACIAL SURGERY
Practice Address - Street 2:650 W BALTIMORE ST. #1216
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-706-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program