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NPI Code Detail

MEDICARE: COOPERMAN FAMILY DENTISTRY PLLC

MEDICARE: COOPERMAN FAMILY DENTISTRY PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center9640AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11225412950OTHERAZNPI TYPE1

General Provider Information

NPI Number : 1417445099
Entity Type Code : Organization
Provider Name (Legal Business Name) : COOPERMAN FAMILY DENTISTRY PLLC
Provider Business Mailing Address
First Line : 25101 N LAKE PLEASANT PKWY # B-1335
Second Line :
City : PEORIA
State : AZ
Zip : 85383-1386
Country : US
Telephone Number : 480-324-6457
Fax Number : 480-680-0921
Provider Business Practice Location Address
First Line : 25101 N LAKE PLEASANT PKWY # B-1335
Second Line :
City : PEORIA
State : AZ
Zip : 85383-1386
Country : US
Telephone Number : 480-324-6457
Fax Number : 480-680-0921
Authorized Official
Title or Position : OWNER
Name : DR. BENJAMIN PETER COOPERMAN
Credential : DMD
Telephone Number : 480-324-6457
Provider Enumeration Date : 04/29/2018
Last Update Date : 04/29/2018

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Directions to “COOPERMAN FAMILY DENTISTRY PLLC ” Practice Location

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