Provider Demographics
NPI:1982647012
Name:COOPER, KATHERINE S (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:S
Last Name:COOPER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6557
Mailing Address - Country:US
Mailing Address - Phone:706-481-8811
Mailing Address - Fax:
Practice Address - Street 1:3606 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6557
Practice Address - Country:US
Practice Address - Phone:706-481-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA124458OtherUNITED CONCORDIA