Provider Demographics
NPI:1679752141
Name:COPE, BENJAMIN D (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:D
Last Name:COPE
Suffix:
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:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725-0820
Mailing Address - Country:US
Mailing Address - Phone:435-878-2775
Mailing Address - Fax:435-878-2778
Practice Address - Street 1:223 S 200 E
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725
Practice Address - Country:US
Practice Address - Phone:435-878-2775
Practice Address - Fax:435-878-2778
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190270121223G0001X
UT6896356-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice