Individual
DR. PHILIP WENDELL COOPER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
413 W DUFFY ST, SAVANNAH, GA 31401-6716
(912) 234-5003
(912) 234-2844
Mailing address
413 W DUFFY ST, SAVANNAH, GA 31401-6716
(912) 234-5003
(912) 234-2844
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
GA8412
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00045251A
—
GA
01
—
9184118
DORAL-GA. MEDICAID
GA
01
—
GA8412
LICENSE
GA
05
—
ZAG994
—
SC
Enumeration date
01/01/2007
Last updated
07/08/2007
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