Provider Demographics
NPI:1861869158
Name:SEYMOUR, COPELIN LINCOLN S (DDS)
Entity type:Individual
Prefix:DR
First Name:COPELIN
Middle Name:LINCOLN S
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W HISTORIC MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3556
Mailing Address - Country:US
Mailing Address - Phone:414-383-2426
Mailing Address - Fax:
Practice Address - Street 1:710 W HISTORIC MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3556
Practice Address - Country:US
Practice Address - Phone:414-383-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001019-15122300000X
MD15720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist