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General NPI Number Information
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NPI Number | 1972832715
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Entity Type | Individual
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Provider Name | JONATHAN M COPELAND D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 2426 TAYLOR RD
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City | WILDWOOD
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State | MO
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Zip | 63040-1222
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Country | US
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Telephone | 636-273-5866
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Fax | 636-273-5349
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Provider Business Mailing Address
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Address Line | 16545 WILLOW GLEN DR
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City | WILDWOOD
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State | MO
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Zip | 63040-1748
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Country | US
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Telephone | 636-273-5866
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Fax | 636-273-5349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2009013176
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License Number State | MO
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