Michael Scott Kopecky, DDS MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

4408 Issued in WI

Practice address

145 N 18TH Avenue
West Bend, WI 53095

Phone

(262) 334-3084

Fax

(262) 334-3552

NPI assigned

Dec 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cedar Lake Dental Professionals LTD

  • General Practice Dentistry
  • West Bend, WI
  • NPI 1790840734

  Prosthodontics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023173069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 N 18TH AVENUE",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "53095",
            "telephone_number": "262-334-3084",
            "fax_number": "262-334-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 N 18TH AVENUE",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "53095",
            "telephone_number": "262-334-3084",
            "fax_number": "262-334-3552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPECKY",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "WI",
            "license": "4408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33761800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "650286",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trischa Margaret Kocher Richmond
• Elizabeth Kofler, RN
• Courtney Kohlmann
• Amber R Koll, PA-C
• Mykala Konrardy
• Suzanne Kordas, LPC-IT
• Kornely Podiatry, LLC
• Lisa Gustine Kornely, D.P.M.
• Samuel Jon Kortes
• Charlene Koslowski

• Prosthodontics in West Bend, WI
• Providers in West Bend, WI by specialty
• Prosthodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.