Provider Demographics
NPI:1821976333
Name:COOPER, KHIA (RDH, BS)
Entity type:Individual
Prefix:
First Name:KHIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:X
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5464 MESA TOP CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3545
Mailing Address - Country:US
Mailing Address - Phone:303-815-4404
Mailing Address - Fax:
Practice Address - Street 1:5400 IDYLWILD TRL UNIT B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3816
Practice Address - Country:US
Practice Address - Phone:720-378-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000903882124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist