Provider Demographics
NPI:1346450152
Name:COOPER, VICKI LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 ALEXANDER BELL DR
Mailing Address - Street 2:SUITE #120
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2122
Mailing Address - Country:US
Mailing Address - Phone:410-872-3999
Mailing Address - Fax:410-872-1133
Practice Address - Street 1:6700 ALEXANDER BELL DR
Practice Address - Street 2:SUITE #120
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2122
Practice Address - Country:US
Practice Address - Phone:410-872-3999
Practice Address - Fax:410-872-1133
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist