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NPI Code Detail

MEDICARE: DR. LAWRENCE LUTHER COPENHAVER III DMD

MEDICARE: DR. LAWRENCE LUTHER COPENHAVER III DMD
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
11223D0001XPublic Health DentistryDN08846FL
2122300000XDentistDN8846FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366409807
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE LUTHER COPENHAVER III DMD
Provider Business Mailing Address
First Line : 2315 W JACKSON ST
Second Line :
City : PENSACOLA
State : FL
Zip : 32505-7552
Country : US
Telephone Number : 850-436-4630
Fax Number : 850-436-2095
Provider Business Practice Location Address
First Line : 1295 W FAIRFIELD DR
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-1107
Country : US
Telephone Number : 850-912-8880
Fax Number : 850-912-8779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 03/27/2025

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