MEDICARE: DR. ROBERT L 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D12555	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D12555	OTHER	TX	DENTAL

General Provider Information

NPI Number	:	1649318783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L COOPER D.D.S.

Provider Business Mailing Address
First Line	:	1003 N JEFFERSON AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-3261
Country	:	US
Telephone Number	:	903-577-1123
Fax Number	:	903-577-1125

Provider Business Practice Location Address
First Line	:	1003 N JEFFERSON AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-3261
Country	:	US
Telephone Number	:	903-577-1123
Fax Number	:	903-577-1125

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ROBERT L COOPER D.D.S.” Practice Location

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