Provider Demographics
NPI:1780012930
Name:COOPER, DAMION O (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAMION
Middle Name:O
Last Name:COOPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7499 GREENBELT RD # 22
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3402
Mailing Address - Country:US
Mailing Address - Phone:301-220-0077
Mailing Address - Fax:
Practice Address - Street 1:7499 GREENBELT RD # 22
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3402
Practice Address - Country:US
Practice Address - Phone:301-220-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice