Provider Demographics
NPI:1467722215
Name:COPPERFIELD SMILE CENTER, LLP
Entity Type:Organization
Organization Name:COPPERFIELD SMILE CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-443-7524
Mailing Address - Street 1:2535 FM 1960 EAST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073
Mailing Address - Country:US
Mailing Address - Phone:281-550-7276
Mailing Address - Fax:281-550-7295
Practice Address - Street 1:15218 WEST RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1916
Practice Address - Country:US
Practice Address - Phone:281-550-7276
Practice Address - Fax:281-550-7295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty