Provider Demographics
NPI:1245535483
Name:COOPER, KAREN PATRICIA (DDS)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:PATRICIA
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 N LAKE DR
Mailing Address - Street 2:APT 5013
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8109
Mailing Address - Country:US
Mailing Address - Phone:740-975-1137
Mailing Address - Fax:
Practice Address - Street 1:125 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3655
Practice Address - Country:US
Practice Address - Phone:803-796-2637
Practice Address - Fax:803-796-5326
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH69571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice