MEDICARE: MARICON DIZON COPELAND 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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	D009816	AZ

General Provider Information

NPI Number	:	1528596400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARICON DIZON COPELAND DMD

Provider Business Mailing Address
First Line	:	7111 E TANQUE VERDE RD STE 107
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3484
Country	:	US
Telephone Number	:	520-318-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 E TANQUE VERDE RD STE 107
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3484
Country	:	US
Telephone Number	:	520-318-4455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	06/08/2026

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Directions to “ MARICON DIZON COPELAND DMD” Practice Location

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