Provider Demographics
NPI:1417965336
Name:COOPER, WALTER ARTHUR III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ARTHUR
Last Name:COOPER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SOUTH YORK STREET
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4036
Mailing Address - Country:US
Mailing Address - Phone:704-864-8757
Mailing Address - Fax:
Practice Address - Street 1:414 SOUTH YORK STREET
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4036
Practice Address - Country:US
Practice Address - Phone:704-864-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899015FMedicaid
NC899015FMedicaid