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General NPI Number Information
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NPI Number | 1467722215
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Entity Type | Organization
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Legal Business Name | COPPERFIELD SMILE CENTER, LLP
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 15218 WEST RD
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City | HOUSTON
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State | TX
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Zip | 77095-1916
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Country | US
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Telephone | 281-550-7276
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Fax | 281-550-7295
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Provider Business Mailing Address
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Address Line | 2535 FM 1960 EAST
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City | HOUSTON
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State | TX
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Zip | 77073
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Country | US
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Telephone | 281-550-7276
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Fax | 281-550-7295
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JASON MICHAEL DERR
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Credential | DDS
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Telephone | 281-443-7524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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