Provider Demographics
NPI:1306076682
Name:COOPER, TODD DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:DANIEL
Last Name:COOPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21534 GREAT MILLS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PK
Mailing Address - State:MD
Mailing Address - Zip Code:20653
Mailing Address - Country:US
Mailing Address - Phone:301-862-3900
Mailing Address - Fax:301-862-3779
Practice Address - Street 1:21534 GREAT MILLS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PK
Practice Address - State:MD
Practice Address - Zip Code:20653
Practice Address - Country:US
Practice Address - Phone:301-862-3900
Practice Address - Fax:301-862-3779
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD14501122300000X
MD14501208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice