Provider Demographics
NPI:1871871699
Name:KOPICKI, ERIN NICOLE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:NICOLE
Last Name:KOPICKI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1457
Mailing Address - Country:US
Mailing Address - Phone:734-657-2064
Mailing Address - Fax:
Practice Address - Street 1:N112W16760 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-5814
Practice Address - Country:US
Practice Address - Phone:262-255-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6778-15122300000X
MI2901020152122300000X
WI67781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist