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General NPI Number Information
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NPI Number | 1871730317
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Entity Type | Organization
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Legal Business Name | RONALD H COPENHAVER DMD PA
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 4338 1ST STREET N SUITE C
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City | ST. PETERSBURG
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State | FL
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Zip | 33703
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Country | US
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Telephone | 727-822-2228
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Fax | 727-822-2441
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Provider Business Mailing Address
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Address Line | 4338 1ST STREET N SUITE C
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City | ST. PETERSBURG
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State | FL
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Zip | 33703
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Country | US
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Telephone | 727-822-2228
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Fax | 727-822-2441
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD H. COPENHAVER
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Credential | D.M.D.,
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Telephone | 727-822-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6749
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License Number State | FL
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