Individual
CHARLES LEE COPPOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1501 E RUSK ST, JACKSONVILLE, TX 75766-5505
(903) 586-2401
Mailing address
1501 E RUSK ST, JACKSONVILLE, TX 75766-5505
(903) 586-2401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12645
TX
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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