Provider Demographics
NPI:1740445964
Name:BENJAMIN D COPE, DDS, PC
Entity type:Organization
Organization Name:BENJAMIN D COPE, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-878-2775
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725-0820
Mailing Address - Country:US
Mailing Address - Phone:435-878-2778
Mailing Address - Fax:
Practice Address - Street 1:223 S 200 E
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725
Practice Address - Country:US
Practice Address - Phone:435-878-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT689635699221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty