Provider Demographics
NPI:1275117905
Name:COPE, ETHAN H (DMD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:H
Last Name:COPE
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 1:498 BUCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3708
Mailing Address - Country:US
Mailing Address - Phone:860-648-2848
Mailing Address - Fax:
Practice Address - Street 1:498 BUCKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3708
Practice Address - Country:US
Practice Address - Phone:860-648-2848
Practice Address - Fax:860-648-2893
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice