Healthcare Provider Details

I. General information

NPI: 1396488359
Provider Name (Legal Business Name): COOPER AND THOMAS ORAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 BISSONNET ST STE 103
BELLAIRE TX
77401-4015
US

IV. Provider business mailing address

5001 BISSONNET ST STE 103
BELLAIRE TX
77401-4015
US

V. Phone/Fax

Practice location:
  • Phone: 713-592-9336
  • Fax: 713-592-9337
Mailing address:
  • Phone: 877-667-7669
  • Fax: 888-920-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARYN SHERFIELD
Title or Position: CREDENTIALING
Credential:
Phone: 877-667-7669