Provider Demographics
NPI:1063630341
Name:JAMES M. COOPER, D.D.S., PA
Entity Type:Organization
Organization Name:JAMES M. COOPER, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-982-7547
Mailing Address - Street 1:308 NORTH JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4018
Mailing Address - Country:US
Mailing Address - Phone:501-982-7547
Mailing Address - Fax:507-985-8421
Practice Address - Street 1:308 NORTH JAMES STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4018
Practice Address - Country:US
Practice Address - Phone:501-982-7547
Practice Address - Fax:507-985-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2008261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1874975OtherUNITED CONCORDIA
AR638266OtherUNITED CONCORDIA
AR5F573OtherARKANSAS BCBS GROUP #
AR58159OtherARKANSAS BCBS IND #
AR5Y893OtherARKANSAS BCBS IND #