Provider Demographics
NPI:1619003118
Name:COOPER, HEWITT JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEWITT
Middle Name:JOHN
Last Name:COOPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1718
Mailing Address - Country:US
Mailing Address - Phone:513-751-3384
Mailing Address - Fax:513-751-6880
Practice Address - Street 1:1305 WILLIAM HOWARD TAFT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1718
Practice Address - Country:US
Practice Address - Phone:513-751-3384
Practice Address - Fax:513-751-6880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0333419Medicaid