Provider Demographics
NPI:1497879621
Name:COOPER, STEVEN IRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:IRA
Last Name:COOPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 NORTHERN BLVD.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576
Mailing Address - Country:US
Mailing Address - Phone:516-627-4151
Mailing Address - Fax:516-627-4388
Practice Address - Street 1:1025 NORTHERN BLVD.
Practice Address - Street 2:SUITE 306
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-627-4151
Practice Address - Fax:516-627-4388
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics