Provider Demographics
NPI:1588044556
Name:COOPER, ELIZABETH (RDH)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2836
Mailing Address - Country:US
Mailing Address - Phone:978-774-1531
Mailing Address - Fax:
Practice Address - Street 1:83 ELM ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2836
Practice Address - Country:US
Practice Address - Phone:978-774-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH10103124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist