MEDICARE: DR. DONALD A COPPOLA 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	1223G0001X	General Practice Dentistry	7998	NJ

General Provider Information

NPI Number	:	1831253558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD A COPPOLA D.D.S.

Provider Business Mailing Address
First Line	:	1200 LAWRENCEVILLE RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-3551
Country	:	US
Telephone Number	:	609-883-1770
Fax Number	:	609-883-1777

Provider Business Practice Location Address
First Line	:	1200 LAWRENCEVILLE RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-3551
Country	:	US
Telephone Number	:	609-883-1770
Fax Number	:	609-883-1777

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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