Provider Demographics
NPI:1811987258
Name:COPELAND, VINCENT HEARD (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:HEARD
Last Name:COPELAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9436 MAYFIELD RD S
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3314
Mailing Address - Country:US
Mailing Address - Phone:901-754-6985
Mailing Address - Fax:
Practice Address - Street 1:4250 FARONIA RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6527
Practice Address - Country:US
Practice Address - Phone:901-332-9170
Practice Address - Fax:901-332-0806
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48541223G0001X
MS2475-891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060418Medicaid
TN3225807Medicaid