Provider Demographics
NPI:1407279003
Name:COOPER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COOPER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRITTS
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:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty