Provider Demographics
NPI:1356899470
Name:RICHARDS-COPPOLA, TAWNY (DDS)
Entity type:Individual
Prefix:
First Name:TAWNY
Middle Name:
Last Name:RICHARDS-COPPOLA
Suffix:
Gender:F
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:PO BOX 462037
Mailing Address - Street 2:1125 N FAIRFAX AVE
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-9998
Mailing Address - Country:US
Mailing Address - Phone:424-438-4998
Mailing Address - Fax:
Practice Address - Street 1:12756 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2309
Practice Address - Country:US
Practice Address - Phone:310-945-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062926122300000X, 1223G0001X
TX34545122300000X, 1223G0001X
CA1058001223G0001X, 122300000X
FLDN222701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice