Healthcare Provider Details

I. General information

NPI: 1144223124
Provider Name (Legal Business Name): GERALD MARCUS COPELAND II D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N ARMENIA AVE
TAMPA FL
33603-2744
US

IV. Provider business mailing address

4501 N ARMENIA AVE
TAMPA FL
33603-2744
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-7167
  • Fax: 813-871-5154
Mailing address:
  • Phone: 813-879-7167
  • Fax: 813-871-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: