Healthcare Provider Details

I. General information

NPI: 1679752141
Provider Name (Legal Business Name): BENJAMIN D COPE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S 200 E
ENTERPRISE UT
84725
US

IV. Provider business mailing address

PO BOX 820
ENTERPRISE UT
84725-0820
US

V. Phone/Fax

Practice location:
  • Phone: 435-878-2775
  • Fax: 435-878-2778
Mailing address:
  • Phone: 435-878-2775
  • Fax: 435-878-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019027012
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6896356-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: