Provider Demographics
NPI:1003869603
Name:COOPER, BRIGETTE REBECCA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:BRIGETTE
Middle Name:REBECCA
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 1:3 MORRIS HALL
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6043
Mailing Address - Country:US
Mailing Address - Phone:507-389-1067
Mailing Address - Fax:507-389-5850
Practice Address - Street 1:3 MORRIS HALL
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6043
Practice Address - Country:US
Practice Address - Phone:507-389-1067
Practice Address - Fax:507-389-5850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4488124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist