Individual
JAVON SELIG COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1515 YANCEYVILLE ST, GREENSBORO, NC 27405-6958
(336) 379-9939
(336) 510-5812
Mailing address
1515 YANCEYVILLE ST, GREENSBORO, NC 27405-6958
(336) 510-5813
(336) 510-5812
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6552
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
799002F
—
NC
01
—
9002F
BCBS NC PROVIDER
NC
Enumeration date
11/14/2006
Last updated
07/14/2011
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