Provider Demographics
NPI:1316954142
Name:COPELAND, SCOTT D (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:COPELAND
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAXR0081OtherBCBS PRE-TX
NH600535OtherUNITED CONCORDIA