# COPPER BASIN ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255175519
- **Authorized official:** KENNETH COCHELL (INSURANCE COORDINATOR)
- **Authorized official phone:** (480) 924-2369

## Contact information

- **Practice address:** 2680 S VAL VISTA DR STE 164, GILBERT, AZ 85295-1638
- **Practice address phone:** (480) 855-3223
- **Mailing address:** 2680 S VAL VISTA DR STE 164, GILBERT, AZ 85295-1638
- **Mailing address phone:** (480) 855-3223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 06/21/2024
- **Last updated:** 06/21/2024