MEDICARE: DR. RALPH WARD COOPER D.M.D.

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	1223G0001X	General Practice Dentistry	5904	KY

General Provider Information

NPI Number	:	1396869905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH WARD COOPER D.M.D.

Provider Business Mailing Address
First Line	:	1209 WOODHURST ST
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-3368
Country	:	US
Telephone Number	:	270-781-2032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 WOODHURST ST
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-3368
Country	:	US
Telephone Number	:	270-781-2032
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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