Provider Demographics
NPI:1063624773
Name:SCOTT COPELAND PA
Entity type:Organization
Organization Name:SCOTT COPELAND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:603-437-0331
Mailing Address - Street 1:132 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1822
Mailing Address - Country:US
Mailing Address - Phone:603-437-0331
Mailing Address - Fax:603-437-5096
Practice Address - Street 1:132 E BROADWAY
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1822
Practice Address - Country:US
Practice Address - Phone:603-437-0331
Practice Address - Fax:603-437-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH600535OtherUNITED CONCORDIA
MAXR0081OtherBCBS PRE-TX