MEDICARE: BRANTLEY W. COPE, DMD DENTISTRY, PA

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	1223G0001X	General Practice Dentistry	4588	SC

General Provider Information

NPI Number	:	1356795918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANTLEY W. COPE, DMD DENTISTRY, PA

Provider Business Mailing Address
First Line	:	3935 SUNSET BLVD STE D
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-2403
Country	:	US
Telephone Number	:	803-794-6464
Fax Number	:	803-794-6483

Provider Business Practice Location Address
First Line	:	3935 SUNSET BLVD STE D
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-2403
Country	:	US
Telephone Number	:	803-794-6464
Fax Number	:	803-794-6483

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. BRANTLEY WARREN COPE
Credential	:	DMD
Telephone Number	:	803-794-6464

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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