Provider Demographics
NPI:1558465906
Name:COPELAND, ROBERT ESTEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ESTEL
Last Name:COPELAND
Suffix:JR
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 1:1546 BARTHOLOMEW CT.
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2070
Mailing Address - Country:US
Mailing Address - Phone:703-938-7525
Mailing Address - Fax:
Practice Address - Street 1:4399 OLD DOMINION DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3207
Practice Address - Country:US
Practice Address - Phone:703-243-8288
Practice Address - Fax:703-243-8288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA051711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05171OtherSTATE LICENSE