Provider Demographics
NPI:1174346555
Name:COOPER, ZANE VIKTORIA (RDH)
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:VIKTORIA
Last Name:COOPER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 NEEDLE CT
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-3124
Mailing Address - Country:US
Mailing Address - Phone:304-240-5664
Mailing Address - Fax:
Practice Address - Street 1:58 WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3800
Practice Address - Country:US
Practice Address - Phone:304-267-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3852124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist