IndividualActive
Ivan Koutsopatriy, DDS
NPI 1497378053 · Prosthodontics · Fort Bragg, NC
Provider details
- NPI number
- 1497378053
- Entity type
- Individual
- Primary specialty
- ProsthodonticsDental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- License
- 30.026114 (OH)
Specialties & taxonomies
Dental Providers
Dental Providers
Student, Health Care
Dental Providers
Practice location
2817 Rock Merritt Ave
Womack Army Medical Center
Fort Bragg, NC 28310-0001
Phone: (910) 907-8922
Approximate (ZIP-level) locationGet directions
Mailing address
2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001
Additional practice locations (2)
- Smoke Bomb Hill Dental ClinicFort Bragg, NC 28310-0001Phone: (910) 907-8922
- 1838 Normandy DrFort Bragg, NC 28310-8503Phone: (191) 043-2422
Registry dates
- Enumerated
- 2020-05-18
- Last updated
- 2026-03-03
- Certified
- 2026-03-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.