Provider Demographics
NPI:1144223124
Name:COPELAND II, GERALD MARCUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MARCUS
Last Name:COPELAND II
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2744
Mailing Address - Country:US
Mailing Address - Phone:813-879-7167
Mailing Address - Fax:813-871-5154
Practice Address - Street 1:4501 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2744
Practice Address - Country:US
Practice Address - Phone:813-879-7167
Practice Address - Fax:813-871-5154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL153861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry