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General NPI Number Information
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NPI Number | 1013285949
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Entity Type | Organization
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Legal Business Name | MARTIN, MARTIN & COPELAND PLLC
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 1721 E LINCOLN AVE
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2478
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Country | US
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Telephone | 509-837-7178
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Fax | 509-837-3117
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Provider Business Mailing Address
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Address Line | PO BOX 979
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City | SUNNYSIDE
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State | WA
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Zip | 98944-0979
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Country | US
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Telephone | 509-837-7178
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Fax | 509-837-3117
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. KENT COPELAND
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Credential | DMD
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Telephone | 509-837-7178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE00010975
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License Number State | WA
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