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General NPI Number Information
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NPI Number | 1063980027
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Entity Type | Organization
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Legal Business Name | KOKOPELLI FAMILY AND COSMETIC DENTAL PLLC
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 1327 E CHANDLER BLVD STE 105
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City | PHOENIX
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State | AZ
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Zip | 85048-6272
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Country | US
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Telephone | 480-283-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 E SARAGOSA ST
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City | CHANDLER
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State | AZ
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Zip | 85225-2094
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Country | US
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Telephone | 480-628-6374
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUPREET SINGH NAGI
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Credential |
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Telephone | 480-628-6374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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