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NPI Code Detail

MEDICARE: DR. WILLIAM T COOPER D.D.S.

MEDICARE: DR. WILLIAM T 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
11223G0001XGeneral Practice Dentistry12424TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D12424OTHERTXTX CHIP ID
284D464OTHERTXBCBS ID

General Provider Information

NPI Number : 1962575530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM T COOPER D.D.S.
Provider Business Mailing Address
First Line : 109 E AVENUE J
Second Line :
City : ROBSTOWN
State : TX
Zip : 78380-2347
Country : US
Telephone Number : 361-387-1531
Fax Number : 387-767-8802
Provider Business Practice Location Address
First Line : 109 E AVENUE J
Second Line :
City : ROBSTOWN
State : TX
Zip : 78380-2347
Country : US
Telephone Number : 361-387-1531
Fax Number : 387-767-8802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 07/09/2007

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