MEDICARE: DR. RICHARD WINFIELD COPELAND JR. DDS

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	122300000X	Dentist	9515	MN

General Provider Information

NPI Number	:	1730125063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WINFIELD COPELAND JR. DDS

Provider Business Mailing Address
First Line	:	25 TAMARISK
Second Line	:
City	:	DELLWOOD
State	:	MN
Zip	:	55110
Country	:	US
Telephone Number	:	651-426-9720
Fax Number	:	651-426-0081

Provider Business Practice Location Address
First Line	:	130 HICKORY ST
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115
Country	:	US
Telephone Number	:	651-426-9720
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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