Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN8846 | FL |
N | 1223D0001X | Dental Public Health | DN08846 | FL |
NPI | 1366409807 |
---|---|
Provider Name | Dr. Lawrence Luther Copenhaver III |
First Address | Pensacola, FL 32503-6418 |
Second Address | Pensacola, FL 32503-6418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 14/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077307700 | (05) | FL |
DN8846 | (02) | FL |