Provider Demographics
NPI:1588233548
Name:COOPER ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:COOPER ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTICS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-790-0319
Mailing Address - Street 1:685 ROYAL PALM BEACH BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7642
Mailing Address - Country:US
Mailing Address - Phone:561-790-0319
Mailing Address - Fax:561-790-4477
Practice Address - Street 1:1718 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6643
Practice Address - Country:US
Practice Address - Phone:561-588-0319
Practice Address - Fax:561-790-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty