Provider Demographics
NPI:1396323283
Name:GREGORY R SOPEL DMD PC
Entity type:Organization
Organization Name:GREGORY R SOPEL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-220-2397
Mailing Address - Street 1:PO BOX 8450
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657-8450
Mailing Address - Country:US
Mailing Address - Phone:830-598-5474
Mailing Address - Fax:
Practice Address - Street 1:9000 HIGHWAY 2147 STE 103
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-6247
Practice Address - Country:US
Practice Address - Phone:830-598-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty