MEDICARE: DR. HEWITT JOHN 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	1223G0001X	General Practice Dentistry	15412	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619003118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEWITT JOHN COOPER D.D.S.

Provider Business Mailing Address
First Line	:	1305 WILLIAM HOWARD TAFT RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1718
Country	:	US
Telephone Number	:	513-751-3384
Fax Number	:	513-751-6880

Provider Business Practice Location Address
First Line	:	1305 WILLIAM HOWARD TAFT RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1718
Country	:	US
Telephone Number	:	513-751-3384
Fax Number	:	513-751-6880

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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