Provider Demographics
NPI:1942986658
Name:COOPER, ANDREW WAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WAYNE
Last Name:COOPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 KY HIGHWAY 590
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-8279
Mailing Address - Country:US
Mailing Address - Phone:606-669-7761
Mailing Address - Fax:
Practice Address - Street 1:603 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1248
Practice Address - Country:US
Practice Address - Phone:606-365-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist