Provider Demographics
NPI:1144740564
Name:SANDERSON, CUTBIRTH & COPELAND PLLC
Entity Type:Organization
Organization Name:SANDERSON, CUTBIRTH & COPELAND PLLC
Other - Org Name:COPELAND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTBIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-356-3721
Mailing Address - Street 1:PO BOX 199
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77353-0199
Mailing Address - Country:US
Mailing Address - Phone:281-356-3721
Mailing Address - Fax:281-356-3778
Practice Address - Street 1:2402 SAM HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5861
Practice Address - Country:US
Practice Address - Phone:936-295-6811
Practice Address - Fax:936-291-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty