NPIMap

Individual provider Active NPI

David Jack Cooper, DDS

  • Dentist
  • Lexington PK, MD
National Provider Identifier
1841452596
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6466 Issued in MD
Practice address
21534 Great Mills Rd
Lexington PK, MD 20653
Phone
(301) 862-3900
Fax
(301) 862-3779
NPI assigned
Jun 25, 2008
Last updated
Jun 25, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6466 MD Primary

Addresses

Primary practice location

21534 Great Mills Rd
Lexington PK, MD 20653

Mailing address

21534 Great Mills Rd
Lexington PK, MD 20653
Phone (301) 862-3900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jul 7, 2015 through Jul 7, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6466MDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater LLC Dentist Past Accepting new patients
Tidewater LLC Dentist PastSince Nov 29, 2020 Accepting new patients
Tidewater LLC Past Accepting new patients
Tidewater LLC Dentist Past Accepting new patients

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214352000000",
    "number": "1841452596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21534 GREAT MILLS RD",
            "city": "LEXINGTON PK",
            "state": "MD",
            "postal_code": "20653",
            "telephone_number": "301-862-3900",
            "fax_number": "301-862-3779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21534 GREAT MILLS RD",
            "city": "LEXINGTON PK",
            "state": "MD",
            "postal_code": "20653",
            "telephone_number": "301-862-3900",
            "fax_number": "301-862-3779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "DAVID",
        "middle_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "6466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington PK, MD

Sources for this page

Verify at the official NPI Registry.