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NPI Code Detail

MEDICARE: JAVON SELIG COOPER DDS

MEDICARE: JAVON SELIG COOPER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6552NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19002FOTHERNCBCBS NC PROVIDER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043382096
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAVON SELIG COOPER DDS
Provider Business Mailing Address
First Line : 1515 YANCEYVILLE ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-6958
Country : US
Telephone Number : 336-510-5813
Fax Number : 336-510-5812
Provider Business Practice Location Address
First Line : 1515 YANCEYVILLE ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-6958
Country : US
Telephone Number : 336-379-9939
Fax Number : 336-510-5812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 07/14/2011

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