Organization
PEDIATRIC DENTISTRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. L LEE COPE D.D.S. (DENTIST)
(601) 922-0066
Entity
Organization
Contact information
Practice address
5315 HIGHWAY 18 W, JACKSON, MS 39209-9421
(601) 922-0066
(601) 922-0077
Mailing address
5315 HIGHWAY 18 W, JACKSON, MS 39209-9421
(601) 922-0066
(601) 922-0077
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1865-80
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064746
—
MS
Enumeration date
06/13/2011
Last updated
06/13/2011
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