Healthcare Provider Details

I. General information

NPI: 1306076682
Provider Name (Legal Business Name): TODD DANIEL COOPER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21534 GREAT MILLS RD
LEXINGTON PK MD
20653
US

IV. Provider business mailing address

21534 GREAT MILLS RD
LEXINGTON PK MD
20653
US

V. Phone/Fax

Practice location:
  • Phone: 301-862-3900
  • Fax: 301-862-3779
Mailing address:
  • Phone: 301-862-3900
  • Fax: 301-862-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberMD14501
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14501
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: