Provider Demographics
NPI:1134536907
Name:COPPER COVE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:COPPER COVE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-446-2080
Mailing Address - Street 1:3473 W SOUTH JORDAN PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-6016
Mailing Address - Country:US
Mailing Address - Phone:801-446-2080
Mailing Address - Fax:801-446-2757
Practice Address - Street 1:3473 W SOUTH JORDAN PKWY STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-6016
Practice Address - Country:US
Practice Address - Phone:801-446-2080
Practice Address - Fax:801-446-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty