Provider Demographics
NPI:1356795918
Name:BRANTLEY W. COPE, DMD DENTISTRY, PA
Entity type:Organization
Organization Name:BRANTLEY W. COPE, DMD DENTISTRY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANTLEY
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-794-6464
Mailing Address - Street 1:3935 SUNSET BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-2403
Mailing Address - Country:US
Mailing Address - Phone:803-794-6464
Mailing Address - Fax:803-794-6483
Practice Address - Street 1:3935 SUNSET BLVD STE D
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-2403
Practice Address - Country:US
Practice Address - Phone:803-794-6464
Practice Address - Fax:803-794-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty