Serge Kupetz, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30605 Issued in TX

Practice address

4840 W Panther Creek Dr Ste 211
Spring, TX 77381-3542

Phone

(832) 791-5550

Fax

(718) 462-2418

NPI assigned

Sep 26, 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

Medicare fee-for-service enrollment

Enrolled in NY

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

Practice roles

Locations

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.

• Coney Island Dental P.C.

  • General Practice Dentistry
  • Brooklyn, NY
  • NPI 1255720322
  Medicare reassignment NPD

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1437250289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 W PANTHER CREEK DR STE 211",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773813542",
            "telephone_number": "832-791-5550",
            "fax_number": "718-462-2418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 W PANTHER CREEK DR STE 211",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773813542",
            "telephone_number": "832-791-5550",
            "fax_number": "718-462-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPETZ",
        "first_name": "SERGE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ju Kuang, M.D.
• Heather Kubiak
• Evelyn Kuhlman, SLP
• Novinyo Kumekpor
• Elisa Meredith Williams Kunkel, MD
• Eric Kurkowski
• Michelle Kutcher
• Kuykendahl Family Dental
• Kuykendahl Medical Center (First Choice Emergency Room)
• Angie Louise Kuykendall

• Dentist in Spring, TX
• Providers in Spring, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.