| NPI | 1255492815 |
|---|---|
| Doing Business As | COPPERFIELD CROSSING DENTAL |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13245) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 12961) |
| 1223G0001X Dentist, General Practice (Licence: TX 13509) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2018-01-03 |