Provider Demographics
NPI:1407738040
Name:COPPINGER DENTAL GROUP LLC
Entity type:Organization
Organization Name:COPPINGER DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-249-9868
Mailing Address - Street 1:325 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 S CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:EARLHAM
Practice Address - State:IA
Practice Address - Zip Code:50072-2000
Practice Address - Country:US
Practice Address - Phone:515-249-9868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty