Provider Demographics
NPI:1780855361
Name:LYNN B. COPELAND, D.M.D., PA
Entity Type:Organization
Organization Name:LYNN B. COPELAND, D.M.D., PA
Other - Org Name:DENTAL CARE OF RICHLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-664-6655
Mailing Address - Street 1:1055 HIGHWAY 49 S STE C
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-7517
Mailing Address - Country:US
Mailing Address - Phone:601-664-6655
Mailing Address - Fax:601-664-7224
Practice Address - Street 1:1055 HIGHWAY 49 S STE C
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-7517
Practice Address - Country:US
Practice Address - Phone:601-664-6655
Practice Address - Fax:601-664-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3124-001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08836308Medicaid