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NPI Code Detail

MEDICARE: ANGELA M COOPER DDS

MEDICARE: ANGELA M 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
11223D0001XPublic Health DentistryDN13255FL

Other Identifiers

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

General Provider Information

NPI Number : 1912994914
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA M COOPER DDS
Provider Business Mailing Address
First Line : 47 5TH ST NW
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33881-4672
Country : US
Telephone Number : 863-291-5110
Fax Number : 863-291-5128
Provider Business Practice Location Address
First Line : 1514 1ST ST N
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33881-2476
Country : US
Telephone Number : 866-234-8534
Fax Number : 863-292-4293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 10/15/2024

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Directions to “ ANGELA M COOPER DDS” Practice Location

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