Provider Demographics
NPI:1629389077
Name:COPELAND, STEPHANIE LYNN MALONEY (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN MALONEY
Last Name:COPELAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9000 WATSON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2217
Mailing Address - Country:US
Mailing Address - Phone:314-842-7500
Mailing Address - Fax:314-842-8401
Practice Address - Street 1:2426 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1222
Practice Address - Country:US
Practice Address - Phone:636-273-5866
Practice Address - Fax:636-273-5349
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100199761223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice