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General NPI Number Information
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NPI Number | 1063718724
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Entity Type | Organization
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Legal Business Name | E.W. COOPER D.D.S
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 515 E WATAUGA AVE
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City | JOHNSON CITY
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State | TN
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Zip | 37601-4038
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Country | US
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Telephone | 423-928-2621
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Fax |
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Provider Business Mailing Address
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Address Line | 515 EAST WATAUGA AVE
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City | JOHNSON CITY
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State | TN
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Zip | 37601-4038
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Country | US
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Telephone | 423-928-2621
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ERNEST W COOPER
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Credential |
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Telephone | 423-928-2621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | TN 3275
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License Number State | TN
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