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General NPI Number Information
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NPI Number | 1992929954
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Entity Type | Organization
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Legal Business Name | A CHOICE DENTAL CARE PLLC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 FAIRFAX AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-4905
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Country | US
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Telephone | 502-895-1171
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Fax | 502-899-7197
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Provider Business Mailing Address
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Address Line | 111 FAIRFAX AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-4905
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Country | US
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Telephone | 502-895-1171
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Fax | 502-899-7197
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT EARL COOPER
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Credential | DMD
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Telephone | 502-895-1171
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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 | 5765
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License Number State | KY
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