MEDICARE: WOODY & COOPER DDS, PA

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
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518973155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODY & COOPER DDS, PA

Provider Business Mailing Address
First Line	:	414 S YORK ST
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4036
Country	:	US
Telephone Number	:	704-865-0490
Fax Number	:	704-864-8757

Provider Business Practice Location Address
First Line	:	414 S YORK ST
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4036
Country	:	US
Telephone Number	:	704-865-0490
Fax Number	:	704-864-8757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WALTER ARTHUR COOPER III
Credential	:	DDS
Telephone Number	:	704-865-0490

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/22/2020

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