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General NPI Number Information
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NPI Number | 1366409807
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Entity Type | Individual
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Provider Name | LAWRENCE LUTHER COPENHAVER III DMD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1295 W FAIRFIELD DR
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City | PENSACOLA
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State | FL
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Zip | 32501-1107
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Country | US
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Telephone | 850-912-8880
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Fax | 850-912-8779
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Provider Business Mailing Address
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Address Line | 2315 W JACKSON ST
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City | PENSACOLA
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State | FL
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Zip | 32505-7552
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Country | US
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Telephone | 850-436-4630
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Fax | 850-436-2095
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DN08846
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN8846
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License Number State | FL
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