DR. Ivan Sergeyevich Koutsopatriy, DDS

NPI #1497378053 in Fort Bragg, North Carolina

Provider Information

NPI Number: 1497378053
Entity Type: Individual
Name: DR. Ivan Sergeyevich Koutsopatriy, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - Prosthodontics
Credential: DDS
Enumeration Date: May 18, 2020
Last Updated: Oct 30, 2025

Practice Location

Address: 2817 ROCK MERRITT AVE
Address 2: WOMACK ARMY MEDICAL CENTER
City: Fort Bragg
State: North Carolina
ZIP Code: 28310-0001
Phone: (910) 907-8922

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Prosthodontics — Prosthodontics	1223P0700X	Primary
Dentist - General Practice — General Practice	1223G0001X
Student in an Organized Health Care Education/Training Program	390200000X
Dentist	122300000X

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