Healthcare Provider Details

I. General information

NPI: 1235580317
Provider Name (Legal Business Name): EMERGENCY DENTIST,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 N SHADELAND AVE SUITE B
INDIANAPOLIS IN
46250-2689
US

IV. Provider business mailing address

5800 N I 35 STE 205
DENTON TX
76207-1438
US

V. Phone/Fax

Practice location:
  • Phone: 317-934-7774
  • Fax:
Mailing address:
  • Phone: 317-672-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008932A
License Number StateIN

VIII. Authorized Official

Name: CRAIG COPELAND
Title or Position: OWNER
Credential:
Phone: 940-220-7833