Jason Marc Kopakin, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN18457 Issued in FL

Practice address

8475 Seminole Blvd
Seminole, FL 33772-4329

Phone

(727) 393-6024

NPI assigned

Jul 2, 2008

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

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• Freedom Health HMO Network

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

• Boulevard Dental, LLC

  • General Practice Dentistry
  • Seminole, FL
  • NPI 1114073590
  NPD (past)

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430697600000",
    "number": "1093978827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 S ALBANY AVE APT 4",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336064315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8475 SEMINOLE BLVD",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724329",
            "telephone_number": "727-393-6024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPAKIN",
        "first_name": "JASON",
        "middle_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-02",
        "last_updated": "2015-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN18457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Ann Koberda
• Alisha Marie Koch
• Douglas L Kole, D.C.
• Kona Alf LLC (The Villas Of Casa Celeste)
• Sofia Konstantinidis
• Kozak P T & Assoc Inc
• John Andrew Kozak, PT
• Nancy Kozak, P.T.
• Mary Ellen Kramp, DPT
• Kelly C Kreutz, LICSW

• Dentist in Seminole, FL
• Providers in Seminole, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.