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Individual

KRISTOPHER COOPER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD, MD

Contact information

Practice address
1 COLLEGE ST, PORTLAND, ME 04103-2617
(207) 283-0171
Mailing address
1 COLLEGE ST, PORTLAND, ME 04103-2617

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DEN4712
ME
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS040600
PA

Other

Enumeration date
06/20/2015
Last updated
09/13/2021
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