Provider Demographics
NPI:1194200840
Name:MARISSA N. COOPER D.M.D., P.A.
Entity Type:Organization
Organization Name:MARISSA N. COOPER D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-215-3555
Mailing Address - Street 1:10651 SW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5856
Mailing Address - Country:US
Mailing Address - Phone:772-215-3555
Mailing Address - Fax:
Practice Address - Street 1:1600 TOWN CENTER CIR STE A
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3641
Practice Address - Country:US
Practice Address - Phone:954-389-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty