Provider Demographics
NPI:1659047678
Name:COPELAN DENTAL, LLC
Entity Type:Organization
Organization Name:COPELAN DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:MALCOM
Authorized Official - Last Name:COPELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-474-6806
Mailing Address - Street 1:451 LOWER HARMONY RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-6080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179 GARRETT WAY NW
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2318
Practice Address - Country:US
Practice Address - Phone:478-453-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental