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NPI Code Detail

MEDICARE: DR. GARY A COOPER DDS

MEDICARE:  DR. GARY A COOPER  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
1122300000XDentist06327NC

General Provider Information

NPI Number : 1669595302
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY A COOPER DDS
Provider Business Mailing Address
First Line : 5232 ALBEMARLE RD
Second Line : SUITE B
City : CHARLOTTE
State : NC
Zip : 28212-2659
Country : US
Telephone Number : 704-567-5955
Fax Number :
Provider Business Practice Location Address
First Line : 5232 ALBEMARLE RD
Second Line : SUITE B
City : CHARLOTTE
State : NC
Zip : 28212-2659
Country : US
Telephone Number : 704-567-5955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 07/08/2007

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Directions to “ DR. GARY A COOPER DDS” Practice Location

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