Mostafa Koperly

Primary specialty

DentistTaxonomy code 122300000X

License

101047 Issued in CA

Practice address

17113 Arrow Blvd
Fontana, CA 92335-3948

Phone

(832) 436-8277

NPI assigned

Jan 10, 2015

Last updated

Feb 28, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 8, 2015 through Dec 8, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Koperly Inc

  • Dental Clinic/Center
  • Edwards, CO
  • NPI 1124489018
  Authorized official Same address or phone
• Colorado Dental Professionals, LLC

  dba Smoky Hill Dental

  • General Practice Dentistry
  • Centennial, CO
  • NPI 1770791790
  NPD (past)

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

{
    "created_epoch": "1420848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1417346727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17113 ARROW BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353948",
            "telephone_number": "832-436-8277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17113 ARROW BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353948",
            "telephone_number": "832-436-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPERLY",
        "first_name": "MOSTAFA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-10",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00202418",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlette Spengler Kolesnik, P.A.-C.
• Ravi Halappa Konchigeri, M.D.
• Lawrence B. Kong, MD
• Nanditha Kongara, MD
• Sean E. Koon, MD
• Thoyaja Koritala, M.D.
• Thelma Z. Korpman, MD
• Bruce R. Koyle, DO
• Maher S. Kozman, MD
• KP Healthcare - Dba Lotus Villa Memory Care (Lotus Villa & Memory Care)

• Dentist in Fontana, CA
• Providers in Fontana, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.