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General NPI Number Information
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NPI Number | 1124464938
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Entity Type | Organization
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Legal Business Name | STEVEN R. & JENNIFER S. COOPER DMD PA
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 1275 W. GRANADA BLVD., SUITE 1
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 386-672-0955
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Fax | 386-672-5177
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Provider Business Mailing Address
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Address Line | 1275 W. GRANADA BLVD., SUITE 1
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 386-672-0955
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Fax | 386-672-5177
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | STEVEN R. COOPER
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Credential | DMD
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Telephone | 386-672-0955
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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 |
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License Number State |
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