MEDICARE: DR. JEFFREY L COPELAND D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9298	TX

General Provider Information

NPI Number	:	1275647661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY L COPELAND D.D.S.

Provider Business Mailing Address
First Line	:	1723 N AVENUE K
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3605
Country	:	US
Telephone Number	:	979-233-1581
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 N AVENUE K
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3605
Country	:	US
Telephone Number	:	979-233-1581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JEFFREY L COPELAND D.D.S.” Practice Location

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