Provider Demographics
NPI:1588984470
Name:DAN COPP, D.D.S., INC.
Entity type:Organization
Organization Name:DAN COPP, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RHOMBERG
Authorized Official - Last Name:COPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-544-8805
Mailing Address - Street 1:1131 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3301
Mailing Address - Country:US
Mailing Address - Phone:805-544-8805
Mailing Address - Fax:805-543-0753
Practice Address - Street 1:1131 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3301
Practice Address - Country:US
Practice Address - Phone:805-544-8805
Practice Address - Fax:805-543-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty