Provider Demographics
NPI:1922455526
Name:COPITHORNE, RICHARD E JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:COPITHORNE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5992 HOWDERSHELL RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-4107
Mailing Address - Country:US
Mailing Address - Phone:314-731-2273
Mailing Address - Fax:
Practice Address - Street 1:5992 HOWDERSHELL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-4107
Practice Address - Country:US
Practice Address - Phone:314-731-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016014753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist