Provider Demographics
NPI:1063980027
Name:KOKOPELLI FAMILY AND COSMETIC DENTAL PLLC
Entity type:Organization
Organization Name:KOKOPELLI FAMILY AND COSMETIC DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUPREET
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:NAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-628-6374
Mailing Address - Street 1:1323 E SARAGOSA ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2094
Mailing Address - Country:US
Mailing Address - Phone:480-628-6374
Mailing Address - Fax:
Practice Address - Street 1:1327 E CHANDLER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6272
Practice Address - Country:US
Practice Address - Phone:480-283-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental