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General NPI Number Information
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NPI Number | 1376032557
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Entity Type | Individual
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Provider Name | DEVON COOPER
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Gender | Male
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 5495 N BEND RD STE 102
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City | BURLINGTON
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State | KY
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Zip | 41005-9378
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Country | US
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Telephone | 859-534-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 1560 3RD ST APT 903
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City | SAN FRANCISCO
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State | CA
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Zip | 94158-2314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10073
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License Number State | KY
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