Provider Demographics
NPI:1649959743
Name:KOPII, POLINA
Entity type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:KOPII
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9756 ATHLETIC WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5377
Mailing Address - Country:US
Mailing Address - Phone:503-995-5623
Mailing Address - Fax:
Practice Address - Street 1:9601 BLACKWELL RD STE 310
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6710
Practice Address - Country:US
Practice Address - Phone:240-428-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD180371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice