Provider Demographics
NPI:1861134595
Name:COOPERSVILLE DENTAL ASSOCIATES INC
Entity type:Organization
Organization Name:COOPERSVILLE DENTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAFLEUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-837-7326
Mailing Address - Street 1:345 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-1265
Mailing Address - Country:US
Mailing Address - Phone:616-837-7326
Mailing Address - Fax:
Practice Address - Street 1:345 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1265
Practice Address - Country:US
Practice Address - Phone:616-837-7326
Practice Address - Fax:616-837-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty