Provider Demographics
NPI:1679093058
Name:KOPF, MOLLY DELORA (DDS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:DELORA
Last Name:KOPF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:DELORA
Other - Last Name:BERKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3012 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2408
Mailing Address - Country:US
Mailing Address - Phone:712-258-0501
Mailing Address - Fax:
Practice Address - Street 1:3012 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2408
Practice Address - Country:US
Practice Address - Phone:712-258-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE75161223X0400X
SDD12611223X0400X
IADDS-097351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics