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General NPI Number Information
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NPI Number | 1558782409
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Entity Type | Organization
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Legal Business Name | COPPE PEDIATRIC DENTAL LLC
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 21 MUZZEY ST STE 5
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City | LEXINGTON
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State | MA
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Zip | 02421-5259
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Country | US
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Telephone | 781-861-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 21 MUZZEY ST STE 5
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City | LEXINGTON
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State | MA
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Zip | 02421-5259
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Country | US
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Telephone | 781-861-6120
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Fax | 781-861-7856
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | CAROLYN COPPE
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Credential |
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Telephone | 781-861-6120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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