Provider Demographics
NPI:1538355953
Name:COPELAND, KENT RIGBY (DMD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:RIGBY
Last Name:COPELAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2478
Mailing Address - Country:US
Mailing Address - Phone:509-837-7178
Mailing Address - Fax:509-837-3117
Practice Address - Street 1:250 CHARDONNAY AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-9529
Practice Address - Country:US
Practice Address - Phone:509-781-6600
Practice Address - Fax:509-781-6603
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5053459Medicaid