Provider Demographics
NPI:1053836619
Name:AUSTIN COPE DMD LLC
Entity Type:Organization
Organization Name:AUSTIN COPE DMD LLC
Other - Org Name:WILDCREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-220-7620
Mailing Address - Street 1:4650 WEDEKIND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-7722
Mailing Address - Country:US
Mailing Address - Phone:775-356-8254
Mailing Address - Fax:775-356-1446
Practice Address - Street 1:4650 WEDEKIND RD STE 1
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-7722
Practice Address - Country:US
Practice Address - Phone:775-356-8254
Practice Address - Fax:775-356-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty