Provider Demographics
NPI:1881751824
Name:POPELAS, KRISTOFER ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTOFER
Middle Name:ALAN
Last Name:POPELAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:RILLTON
Mailing Address - State:PA
Mailing Address - Zip Code:15678-0425
Mailing Address - Country:US
Mailing Address - Phone:724-446-2727
Mailing Address - Fax:724-446-2700
Practice Address - Street 1:206 OAK ST.
Practice Address - Street 2:SUITE 3
Practice Address - City:RILLTON
Practice Address - State:PA
Practice Address - Zip Code:15678
Practice Address - Country:US
Practice Address - Phone:724-446-2727
Practice Address - Fax:724-446-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036935122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist