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General NPI Number Information
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NPI Number | 1972574960
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Entity Type | Organization
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Legal Business Name | GW COOPER AND RM SHIFMAN DENTAL CORPORATION
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2772 JOHNSON DR SUITE 101
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City | VENTURA
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State | CA
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Zip | 93003-8582
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Country | US
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Telephone | 805-658-1577
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Fax | 805-658-7049
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Provider Business Mailing Address
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Address Line | 2772 JOHNSON DR SUITE 101
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City | VENTURA
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State | CA
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Zip | 93003-8582
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Country | US
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Telephone | 805-658-1577
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Fax | 805-658-7049
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Authorized Official
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Title or Position | SHAREHOLDER/DIRECTOR
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Name | DR. GARY W. COOPER
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Credential | DDS
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Telephone | 805-658-1577
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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 | 50370
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 26831
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License Number State | CA
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