Provider Demographics
NPI:1679326938
Name:COPPERMINE MADERA CANYON LLC
Entity Type:Organization
Organization Name:COPPERMINE MADERA CANYON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:685 S PECAN TREE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5114
Mailing Address - Country:US
Mailing Address - Phone:520-625-1600
Mailing Address - Fax:520-838-0865
Practice Address - Street 1:685 S PECAN TREE LN
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5114
Practice Address - Country:US
Practice Address - Phone:520-625-1600
Practice Address - Fax:520-838-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty