Provider Demographics
NPI:1801092754
Name:MICHAEL B COPP, DDS INC
Entity type:Organization
Organization Name:MICHAEL B COPP, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COPP
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:619-435-3185
Mailing Address - Street 1:1125 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3401
Mailing Address - Country:US
Mailing Address - Phone:619-435-3185
Mailing Address - Fax:619-435-6560
Practice Address - Street 1:1125 10TH ST
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3401
Practice Address - Country:US
Practice Address - Phone:619-435-3185
Practice Address - Fax:619-435-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty