Active NPI
Samuel Joseph Coppola Jr., DDS
- Endodontics
- Portland, ME
National Provider Identifier
1457536567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 2963
- Practice address
- 82 Coyle Street
Portland, ME 04101 - Phone
- (207) 775-4461
- NPI assigned
- Jan 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 2963 | ME | Primary |
Addresses
Primary practice location
82 Coyle Street
Portland, ME 04101
Mailing address
82 Coyle Street
Portland, ME 04101
Phone (207) 775-4461
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2963 | ME | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endodontic Associates | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Health Maintenance Organization
- Portland, ME
- NPI 1861611949
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402963200000",
"number": "1457536567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "82 COYLE STREET",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04101",
"telephone_number": "207-775-4461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82 COYLE STREET",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04101",
"telephone_number": "207-775-4461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPOLA",
"first_name": "SAMUEL",
"middle_name": "JOSEPH",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-08",
"last_updated": "2014-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "ME",
"license": "2963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.