Provider Demographics
NPI:1083817217
Name:COOPER, CAMELIA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAMELIA
Middle Name:NICOLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E VISTA RIDGE MALL DR
Mailing Address - Street 2:APT #627
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3715
Mailing Address - Country:US
Mailing Address - Phone:919-423-9442
Mailing Address - Fax:
Practice Address - Street 1:2430 SOUTH I-35E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205
Practice Address - Country:US
Practice Address - Phone:940-891-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice