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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