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General NPI Number Information
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NPI Number | 1801092754
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Entity Type | Organization
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Legal Business Name | MICHAEL B COPP, DDS INC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1125 10TH ST
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City | CORONADO
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State | CA
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Zip | 92118-3401
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Country | US
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Telephone | 619-435-3185
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Fax | 619-435-6560
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Provider Business Mailing Address
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Address Line | 1125 10TH ST
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City | CORONADO
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State | CA
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Zip | 92118-3401
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Country | US
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Telephone | 619-435-3185
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Fax | 619-435-6560
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL B COPP
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Credential | D. D. S.
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Telephone | 619-435-3185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37325
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License Number State | CA
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