Provider Demographics
NPI:1427413681
Name:GERALD M COPELAND II DMD
Entity Type:Organization
Organization Name:GERALD M COPELAND II DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-879-7167
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN153861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty