Provider Demographics
NPI:1376692152
Name:COOPER, EMILY C (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:C
Last Name:COOPER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:HORTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3359 HIGHWAY 9 E
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7826
Mailing Address - Country:US
Mailing Address - Phone:843-399-2525
Mailing Address - Fax:
Practice Address - Street 1:3359 HIGHWAY 9 E
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7826
Practice Address - Country:US
Practice Address - Phone:843-399-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice