Provider Demographics
NPI:1417445099
Name:COOPERMAN FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:COOPERMAN FAMILY DENTISTRY PLLC
Other - Org Name:BENJAMIN COOPERMAN DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:COOPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-324-6457
Mailing Address - Street 1:25101 N LAKE PLEASANT PKWY # B-1335
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1386
Mailing Address - Country:US
Mailing Address - Phone:480-324-6457
Mailing Address - Fax:480-680-0921
Practice Address - Street 1:25101 N LAKE PLEASANT PKWY # B-1335
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1386
Practice Address - Country:US
Practice Address - Phone:480-324-6457
Practice Address - Fax:480-680-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9640261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1225412950OtherNPI TYPE1