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1629389077 NPI number — STEPHANIE LYNN MALONEY COPELAND DDS

NPI Number: 1629389077
Health Care Provider/Practitioner: STEPHANIE LYNN MALONEY COPELAND DDS

Information about “1629389077” NPI (STEPHANIE LYNN MALONEY COPELAND DDS) exists in 1629389077 in HTML format HTML  |  1629389077 in plain Text format TXT  |  1629389077 in PDF (Portable Document Format) PDF  |  1629389077 in an XML format XML  formats.

NPI Number : 1629389077 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629389077",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COPELAND",
    "FirstName": "STEPHANIE",
    "MiddleName": "LYNN MALONEY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MALONEY",
    "OtherFirstName": "STEPHANIE",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "9000 WATSON RD",
    "SecondLineMailingAddress": "SUITE 101",
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63126-2217",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-842-7500",
    "MailingAddressFaxNumber": "314-842-8401",
    "FirstLinePracticeLocationAddress": "2426 TAYLOR RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILDWOOD",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63040-1222",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "636-273-5866",
    "PracticeLocationAddressFaxNumber": "636-273-5349",
    "EnumerationDate": "06/30/2010",
    "LastUpdateDate": "11/11/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "2010019976",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "2010019976",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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