Provider Demographics
NPI:1629294640
Name:COOPERATING DENTAL MANAGEMENT GROUP INC.
Entity Type:Organization
Organization Name:COOPERATING DENTAL MANAGEMENT GROUP INC.
Other - Org Name:SOUTHMOOR DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALEBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-444-9849
Mailing Address - Street 1:1685 LOCKBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1476
Mailing Address - Country:US
Mailing Address - Phone:614-444-9849
Mailing Address - Fax:614-444-0811
Practice Address - Street 1:1685 LOCKBOURNE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1476
Practice Address - Country:US
Practice Address - Phone:614-444-9849
Practice Address - Fax:614-444-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty