Provider Demographics
NPI:1639356611
Name:VINCENT H COPELAND
Entity Type:Organization
Organization Name:VINCENT H COPELAND
Other - Org Name:VINCENT H COPELAND DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:662-363-2663
Mailing Address - Street 1:1040 HWY 61 SOUTH
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-1918
Mailing Address - Country:US
Mailing Address - Phone:662-363-2663
Mailing Address - Fax:
Practice Address - Street 1:1040 HIGHWAY 61 SOUTH
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676
Practice Address - Country:US
Practice Address - Phone:662-363-2663
Practice Address - Fax:662-363-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09676370Medicaid
MS00060418Medicaid