Provider Demographics
NPI:1689768806
Name:COPPOLA, DONNA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WHEATFIELD DR
Mailing Address - Street 2:STE D
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337
Mailing Address - Country:US
Mailing Address - Phone:570-296-2259
Mailing Address - Fax:570-296-9475
Practice Address - Street 1:102 WHEATFIELD DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337
Practice Address - Country:US
Practice Address - Phone:570-296-2259
Practice Address - Fax:570-296-9475
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS02570L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice