Carlos E Copello, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019034393 Issued in IL

Practice address

1333 S Wabash Ave Unit 2012
Chicago, IL 60605-2630

Phone

(404) 446-5742

NPI assigned

Jun 16, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Identical Smiles LLC

  • General Practice Dentistry
  • Oak Lawn, IL
  • NPI 1760377279
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1902581192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 S WABASH AVE UNIT 2012",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052630",
            "telephone_number": "404-446-5742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 S WABASH AVE UNIT 2012",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052630",
            "telephone_number": "404-446-5742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPELLO",
        "first_name": "CARLOS",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-16",
        "last_updated": "2023-06-16",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019034393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Copeland
• Maureen Copeland, D.D.S.
• Raphael Copeland, PTA
• Ross Graham Copeland, DPT
• Tyson Tryon Copeland
• Mario E Copello, DMD
• Copernicus Medical Corporation.,LTD.
• Copes Special Needs Services LLP
• Valerie Copits
• Shirley Margaret Copland, PT

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.