Provider Demographics
NPI:1932810454
Name:COPELAND FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:COPELAND FAMILY DENTISTRY, PLLC
Other - Org Name:COPELAND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-702-0708
Mailing Address - Street 1:2402 SAM HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5861
Mailing Address - Country:US
Mailing Address - Phone:281-381-0237
Mailing Address - Fax:
Practice Address - Street 1:2402 SAM HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5861
Practice Address - Country:US
Practice Address - Phone:281-381-0237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty