MEDICARE: GERALD M COPELAND II DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN15386	FL

General Provider Information

NPI Number	:	1427413681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD M COPELAND II DMD

Provider Business Mailing Address
First Line	:	4501 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2744
Country	:	US
Telephone Number	:	813-879-7167
Fax Number	:	813-871-5154

Provider Business Practice Location Address
First Line	:	4501 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2744
Country	:	US
Telephone Number	:	813-879-7167
Fax Number	:	813-871-5154

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERALD MARCUS COPELAND II
Credential	:	DMD
Telephone Number	:	813-879-7167

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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