Provider Demographics
NPI:1255637195
Name:MICHAEL R COPPE DMD
Entity type:Organization
Organization Name:MICHAEL R COPPE DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:COPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-861-6120
Mailing Address - Street 1:19 MUZZEY ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 MUZZEY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5256
Practice Address - Country:US
Practice Address - Phone:781-861-6120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0207772Medicaid
MA1639264435OtherNPI