Healthcare Provider Details

I. General information

NPI: 1407718075
Provider Name (Legal Business Name): COOPER OWENS DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E MAIN ST
GENEVA OH
44041-1481
US

IV. Provider business mailing address

220 E MAIN ST
GENEVA OH
44041-1481
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-4884
  • Fax: 330-319-7545
Mailing address:
  • Phone: 440-466-4884
  • Fax: 330-319-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL OWENS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 440-466-4884