Provider Demographics
NPI:1487287314
Name:COOP DENTAL PLLC
Entity type:Organization
Organization Name:COOP DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LIGERAKIS
Authorized Official - Last Name:COOP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-634-2301
Mailing Address - Street 1:1121 N SAGINAW ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1380
Mailing Address - Country:US
Mailing Address - Phone:248-634-2301
Mailing Address - Fax:248-634-6929
Practice Address - Street 1:1121 N SAGINAW ST STE 4
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1380
Practice Address - Country:US
Practice Address - Phone:248-634-2301
Practice Address - Fax:248-634-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty