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General NPI Number Information
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NPI Number | 1679872741
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Entity Type | Organization
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Legal Business Name | COPELAND FAMILY DENTAL PC
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 206 W COUNTY LINE RD STE 360
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-2321
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Country | US
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Telephone | 303-791-8530
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Fax | 303-791-8539
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Provider Business Mailing Address
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Address Line | 206 W COUNTY LINE RD STE 360
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129
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Country | US
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Telephone | 303-791-8530
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Fax | 303-791-8539
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. GREGORY HEATH COPELAND
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Credential | DDS
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Telephone | 303-791-8530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10120
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License Number State | CO
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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 | 10121
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License Number State | CO
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