Individual
DR. JEREMY J KOPPENHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
351 W 6TH STREET, BLDG 440, FORT STEWART, GA 31314
(912) 435-7006
Mailing address
351 W 6TH STREET, BLDG 440, FORT STEWART, GA 31314
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS38003
PA
1223P0700X
Prosthodontics
Primary
DS038003
PA
Other
Enumeration date
08/06/2009
Last updated
10/19/2018
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