Provider Demographics
NPI:1942547443
Name:COPPERFIELD FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:COPPERFIELD FAMILY DENTISTRY, PLLC
Other - Org Name:MY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUJIB
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHRAFI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:816-878-5624
Mailing Address - Street 1:7825 HIGHWAY 6 N
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1700
Mailing Address - Country:US
Mailing Address - Phone:281-463-3033
Mailing Address - Fax:
Practice Address - Street 1:7825 HIGHWAY 6 N
Practice Address - Street 2:SUITE # 108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1700
Practice Address - Country:US
Practice Address - Phone:281-463-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 1223P0221X, 1223P0300X, 1223X0008X, 1223X0400X, 124Q00000X, 126800000X
TX235461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty