Provider Demographics
NPI:1588027361
Name:COPPERFIELD FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:COPPERFIELD FAMILY DENTISTRY, PLLC
Other - Org Name:MY DENTAL OF SUGARLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MUJIB
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHRAFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-494-7645
Mailing Address - Street 1:4965 SWEETWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3133
Mailing Address - Country:US
Mailing Address - Phone:281-494-7645
Mailing Address - Fax:281-494-4624
Practice Address - Street 1:4965 SWEETWATER BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3133
Practice Address - Country:US
Practice Address - Phone:281-494-7645
Practice Address - Fax:281-494-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty