Provider Demographics
NPI:1760595862
Name:COOPER, RONALD B (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
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 1:9 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451
Mailing Address - Country:US
Mailing Address - Phone:843-971-6864
Mailing Address - Fax:843-971-6501
Practice Address - Street 1:3404 SALTERBECK ST
Practice Address - Street 2:BAY TREE ORTHODONTICS SUITE 204
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:843-971-6864
Practice Address - Fax:843-971-6501
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2318122300000X
SC02541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics