MEDICARE: VALERIE ELAINE COOPER D.D.S.

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
1	1223P0700X	Prosthodontics	30023136	OH

General Provider Information

NPI Number	:	1225364326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE ELAINE COOPER D.D.S.

Provider Business Mailing Address
First Line	:	6438 WILMINGTON PIKE
Second Line	:	SUITE 205
City	:	DAYTON
State	:	OH
Zip	:	45459-7010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6438 WILMINGTON PIKE
Second Line	:	SUITE 205
City	:	DAYTON
State	:	OH
Zip	:	45459-7010
Country	:	US
Telephone Number	:	937-254-5760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	04/28/2011

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