Provider Demographics
NPI:1740420488
Name:COOPER, THOMAS HOMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HOMER
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 1:2505 W. CERVANTES ST.
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-7152
Mailing Address - Country:US
Mailing Address - Phone:850-433-5360
Mailing Address - Fax:850-439-2805
Practice Address - Street 1:2505 W. CERVANTES ST.
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-7152
Practice Address - Country:US
Practice Address - Phone:850-433-5360
Practice Address - Fax:850-439-2805
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN4280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist