Provider Demographics
NPI:1164505749
Name:COPE, ANTHONY MITT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MITT
Last Name:COPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 EAST WASHINGTON ST
Mailing Address - Street 2:D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3060
Mailing Address - Country:US
Mailing Address - Phone:317-359-2308
Mailing Address - Fax:317-359-0010
Practice Address - Street 1:9602 EAST WASHINGTON ST
Practice Address - Street 2:D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3060
Practice Address - Country:US
Practice Address - Phone:317-359-2308
Practice Address - Fax:317-359-0010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008560B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200220240AMedicaid