Provider Demographics
NPI:1366549982
Name:COPETAS, CONSTANCE C (DDS)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:C
Last Name:COPETAS
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 1:520 S. COWLEY ST #105
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-747-5586
Mailing Address - Fax:509-624-9288
Practice Address - Street 1:520 S. COWLEY ST. #105
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-747-5586
Practice Address - Fax:509-624-9288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000057851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice