Individual
DR. KEITH M. COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
11050 N SAGUARO BLVD, FOUNTAIN HILLS, AZ 85268-5549
(480) 837-1315
Mailing address
14312 N 31ST PLACE, PHOENIX, AZ 85032
(408) 253-4150
(408) 253-1979
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009480
AZ
1223P0700X
Prosthodontics
39778
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
770434153
FED TX ID
CA
Enumeration date
04/09/2012
Last updated
08/25/2023
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