Individual
DR. KENNETH BRUCE COOPERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
355 E 149TH ST, SUITE 202, BRONX, NY 10455-3909
(718) 993-5454
(718) 993-5455
Mailing address
355 E 149TH ST, SUITE 202, BRONX, NY 10455-3909
(718) 993-5454
(718) 993-5455
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
046957-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02207707
—
NY
Enumeration date
07/14/2010
Last updated
07/14/2010
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