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Organization
LUSBY DENTAL LLC
Active
Organization
LUSBY DENTAL LLC
Active
Other names
Tidewater Dental Lusby
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID JACK COOPER DDS (OWNER)
(410) 326-4078
Entity
Organization
Contact information
Practice address
10025 HG TRUEMAN ROAD, LUSBY, MD 20657
(301) 862-3900
Mailing address
10025 HG TRUEMAN RD, LUSBY, MD 20657-2868
(410) 326-4078
(410) 326-9311
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/16/2015
Last updated
03/10/2016
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