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General NPI Number Information
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NPI Number | 1356533616
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Entity Type | Organization
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Legal Business Name | JEFFREY M. COOPER, D.M.D., P.A.
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 18947 JOHN J WILLIAMS HWY SUITE 301
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4474
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Country | US
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Telephone | 302-645-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 18947 JOHN J WILLIAMS HWY SUITE 301
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4474
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Country | US
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Telephone | 302-645-7200
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JEFFREY MICHAEL COOPER
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Credential | D.M.D.
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Telephone | 302-645-7200
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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 | G1-0001196
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License Number State | DE
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