Provider Demographics
NPI:1518973155
Name:WOODY & COOPER DDS, PA
Entity Type:Organization
Organization Name:WOODY & COOPER DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-865-0490
Mailing Address - Street 1:414 S YORK ST
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:704-865-0490
Mailing Address - Fax:704-864-8757
Practice Address - Street 1:414 S YORK ST
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:704-865-0490
Practice Address - Fax:704-864-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011YKMedicaid