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 |