Provider Demographics
NPI:1235565979
Name:COOPER STREET DENTAL PLLC
Entity Type:Organization
Organization Name:COOPER STREET DENTAL PLLC
Other - Org Name:COOPER STREET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-841-2305
Mailing Address - Street 1:6204 S COOPER ST
Mailing Address - Street 2:STE. 104
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5700
Mailing Address - Country:US
Mailing Address - Phone:972-841-2305
Mailing Address - Fax:
Practice Address - Street 1:6204 S COOPER ST
Practice Address - Street 2:STE. 104
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:214-766-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty