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General NPI Number Information
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NPI Number | 1194523878
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Entity Type | Organization
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Legal Business Name | KOKOPELLI DENTISTRY CHANDLER PLLC
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 975 E RIGGS RD STE 108
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City | CHANDLER
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State | AZ
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Zip | 85249-4260
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Country | US
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Telephone | 480-895-3252
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Fax | 480-452-1267
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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 | MEMBER
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Name | SUPREET S. NAGI
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Credential |
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Telephone | 480-462-9745
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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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