MEDICARE: BENJAMIN D COPE DDS

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	019027012	IL
2	1223G0001X	General Practice Dentistry	6896356-9922	UT

General Provider Information

NPI Number	:	1679752141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN D COPE DDS

Provider Business Mailing Address
First Line	:	PO BOX 820
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725-0820
Country	:	US
Telephone Number	:	435-878-2775
Fax Number	:	435-878-2778

Provider Business Practice Location Address
First Line	:	223 S 200 E
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725
Country	:	US
Telephone Number	:	435-878-2775
Fax Number	:	435-878-2778

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	07/28/2008

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Directions to “ BENJAMIN D COPE DDS” Practice Location

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