MEDICARE: DEBORAH COOPER-NEWLAND 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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1669047171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBORAH COOPER-NEWLAND DDS

Provider Business Mailing Address
First Line	:	5001 BISSONNET ST STE 103
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4015
Country	:	US
Telephone Number	:	713-592-9336
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 BISSONNET ST STE 103
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4015
Country	:	US
Telephone Number	:	713-592-9336
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH COOPER-NEWLAND
Credential	:	DDS
Telephone Number	:	713-592-9336

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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