Provider Demographics
NPI:1215159645
Name:COOPER DENTISTRY LLC
Entity type:Organization
Organization Name:COOPER DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIRIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-964-1000
Mailing Address - Street 1:78 N COOPER RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5210
Mailing Address - Country:US
Mailing Address - Phone:480-964-1000
Mailing Address - Fax:480-964-3076
Practice Address - Street 1:78 N COOPER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5210
Practice Address - Country:US
Practice Address - Phone:480-964-1000
Practice Address - Fax:480-964-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1886358OtherUCCI
AZ75643OtherDHA
AZ253383OtherDBP