# COPPER STATE DENTISTRY LLC

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

## Provider details

- **NPI number:** 1760264816
- **Authorized official:** KYLE WOMELDORFF (OWNER)
- **Authorized official phone:** (480) 690-5200

## Contact information

- **Practice address:** 857 E WARNER RD STE 103, GILBERT, AZ 85296-3076
- **Practice address phone:** (480) 690-5200
- **Mailing address:** 14242 S 47TH ST, PHOENIX, AZ 85044-6205

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/13/2023
- **Last updated:** 10/13/2023