Individual
DR. KEITH D COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12 S JACKSON ST, PERRYVILLE, MO 63775-2515
(573) 547-6520
(573) 547-8272
Mailing address
12 S JACKSON ST, PERRYVILLE, MO 63775-2515
(573) 547-6520
(573) 547-8272
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE015824
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1582048
UNITED CONCORDIA
MO
Enumeration date
08/21/2006
Last updated
07/08/2007
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