Provider Demographics
NPI:1417165267
Name:COOPER COSMETIC & FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COOPER COSMETIC & FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-225-8718
Mailing Address - Street 1:4830 CHATEAU AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4806
Mailing Address - Country:US
Mailing Address - Phone:843-225-8718
Mailing Address - Fax:843-225-8728
Practice Address - Street 1:4830 CHATEAU AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4806
Practice Address - Country:US
Practice Address - Phone:843-225-8718
Practice Address - Fax:843-225-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty