Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 19049 | CA |
NPI | 1083790224 |
---|---|
Provider Name | Dr. Brian Charles Cooper |
First Address | Placentia, CA 92870 |
Second Address | Placentia, CA 92870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |