Provider Demographics
NPI:1255422507
Name:COOPER, CHARLES HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOWARD
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 1:5936 HUBBARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:70852
Mailing Address - Country:US
Mailing Address - Phone:301-881-4430
Mailing Address - Fax:301-881-4431
Practice Address - Street 1:5936 HUBBARD DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:70852
Practice Address - Country:US
Practice Address - Phone:301-881-4430
Practice Address - Fax:301-881-4431
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist