Provider Demographics
NPI:1063982957
Name:COPELAND, JASMINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
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:901-332-0806
Practice Address - Street 1:1251 WESLEY DR STE 130
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6443
Practice Address - Country:US
Practice Address - Phone:901-332-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4185-211223G0001X
TNDS00000108531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty