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NPI Code Detail

MEDICARE: DR. AMY KATHLEEN COOPER DMD

MEDICARE: DR. AMY KATHLEEN COOPER DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist4103SC

General Provider Information

NPI Number : 1205989142
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY KATHLEEN COOPER DMD
Provider Business Mailing Address
First Line : 1233 BLUE SKY LN
Second Line :
City : CHARLESTON
State : SC
Zip : 29492-8158
Country : US
Telephone Number : 843-864-9949
Fax Number :
Provider Business Practice Location Address
First Line : 4515 SPRUILL AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-4764
Country : US
Telephone Number : 843-225-8718
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/24/2007

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