Provider Demographics
NPI:1023138534
Name:KUPIEC, KARSON A (DDS,MS)
Entity type:Individual
Prefix:
First Name:KARSON
Middle Name:A
Last Name:KUPIEC
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 AMPHITHEATRE DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2615
Mailing Address - Country:US
Mailing Address - Phone:858-720-9096
Mailing Address - Fax:760-634-4870
Practice Address - Street 1:617 SAXONY PL STE 103
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2797
Practice Address - Country:US
Practice Address - Phone:760-634-4800
Practice Address - Fax:760-634-4870
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics