Provider Demographics
NPI:1366587073
Name:COPLIN, MATTHEW DONAL (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DONAL
Last Name:COPLIN
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 1:1314 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2950
Mailing Address - Country:US
Mailing Address - Phone:406-442-1377
Mailing Address - Fax:406-442-3011
Practice Address - Street 1:1314 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2950
Practice Address - Country:US
Practice Address - Phone:406-442-1377
Practice Address - Fax:406-442-3011
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5512522OtherCHIPS PROVIDER
MT21434OtherBLUE CROSS BLUE SHIELD
MT0113087Medicaid