Stephen Thomas Coppola, D.M.D.
Individual provider Active NPI General Practice Dentistry · Prospect, CT
NPI 1962852814 · NPPES record last updated Feb 24, 2022
Key facts
- NPI
- 1962852814
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 11643 (CT)
- Practice address
- 44 Center St
Prospect, CT 06712-1639 - Phone
- (203) 758-6639
- NPI assigned
- Jun 21, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11643 | CT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11643 | CT | Yes |
Addresses
Primary practice location
44 Center St
Prospect, CT 06712-1639
Mailing address
1692 E Main St
Torrington, CT 06790-3519
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- Kathryn Cyr
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- Jeffrey Paul Dalessandro
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All providers in Prospect, CT · General Practice Dentistry in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.