| Organization Name: | KOPERLY INC |
| NPI Number: | 1124489018 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MOSTAFA S KOPERLY (PRESIDENT) |
| Mailing Address: | 27 Main St Unit 104 Edwards |
| State: | CO US |
| Postal Code: | 816328109 |
| Phone Number: | 8324368277 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2016 |
| NPI Last Update Date: | 03/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DEN00202418 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |