# KOKOPELLI FAMILY AND COSMETIC DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kokopelli Family and Cosmetic Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063980027
- **Authorized official:** SUPREET SINGH NAGI (OWNER)
- **Authorized official phone:** (480) 628-6374

## Contact information

- **Practice address:** 1327 E CHANDLER BLVD STE 105, PHOENIX, AZ 85048-6272
- **Practice address phone:** (480) 283-0733
- **Mailing address:** 1323 E SARAGOSA ST, CHANDLER, AZ 85225-2094
- **Mailing address phone:** (480) 628-6374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/07/2018
- **Last updated:** 11/07/2018