Provider Demographics
NPI:1679872741
Name:COPELAND FAMILY DENTAL PC
Entity type:Organization
Organization Name:COPELAND FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-791-8530
Mailing Address - Street 1:206 W COUNTY LINE RD STE 360
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129
Mailing Address - Country:US
Mailing Address - Phone:303-791-8530
Mailing Address - Fax:303-791-8539
Practice Address - Street 1:206 W COUNTY LINE RD STE 360
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2321
Practice Address - Country:US
Practice Address - Phone:303-791-8530
Practice Address - Fax:303-791-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10121122300000X
CO10120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty