Individual
DR. RODERICK SAMPSON COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7934 N LINDBERGH BLVD, HAZELWOOD, MO 63042-3521
(314) 831-8086
(314) 831-9563
Mailing address
7934 N LINDBERGH BLVD, HAZELWOOD, MO 63042-3521
(314) 831-8086
(314) 831-9563
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12010881A
IN
1223G0001X
General Practice Dentistry
Primary
2005027478
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100251550A
—
IN
01
—
12010881A
DENTAL LICENSE
IN
Enumeration date
08/09/2006
Last updated
07/23/2009
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