Provider Demographics
NPI:1205989142
Name:COOPER, AMY KATHLEEN (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:KATHLEEN
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 1:1233 BLUE SKY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8158
Mailing Address - Country:US
Mailing Address - Phone:843-864-9949
Mailing Address - Fax:
Practice Address - Street 1:4515 SPRUILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4764
Practice Address - Country:US
Practice Address - Phone:843-225-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist