Individual
KEVIN COPPELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
101077
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
34607
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
157675
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
34607
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/08/2011
Last updated
10/31/2019
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