Provider Demographics
NPI:1437324688
Name:KEVIN C COOPER DDS PC
Entity Type:Organization
Organization Name:KEVIN C COOPER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-483-5152
Mailing Address - Street 1:3105 WESTERN BRANCH BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5543
Mailing Address - Country:US
Mailing Address - Phone:757-483-5152
Mailing Address - Fax:757-483-7711
Practice Address - Street 1:3105 WESTERN BRANCH BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5543
Practice Address - Country:US
Practice Address - Phone:757-483-5152
Practice Address - Fax:757-483-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007725OtherDORAL DENTAL