Healthcare Provider Details

I. General information

NPI: 1518334705
Provider Name (Legal Business Name): EMERGENCY DENTIST,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 US 31 S G
INDIANAPOLIS IN
46227-8685
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 317-672-7582
  • Fax: 317-672-7524
Mailing address:
  • Phone: 940-220-7833
  • Fax: 317-672-7524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009586A
License Number StateIN

VIII. Authorized Official

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