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General NPI Number Information
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NPI Number | 1376658815
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Entity Type | Organization
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Legal Business Name | MITCH COOPER DDS PA
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1813 SW FAIRLAWN RD
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City | TOPEKA
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State | KS
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Zip | 66604-3646
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Country | US
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Telephone | 785-272-9443
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Fax | 785-228-9071
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Provider Business Mailing Address
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Address Line | 1813 SW FAIRLAWN RD
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City | TOPEKA
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State | KS
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Zip | 66604-3646
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Country | US
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Telephone | 785-272-9443
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Fax | 785-228-9071
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | MITCH COOPER
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Credential | DDS
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Telephone | 785-272-9443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5956
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License Number State | KS
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