Provider Demographics
NPI:1205840170
Name:COONEY, JALEH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JALEH
Middle Name:A
Last Name:COONEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 HIGH ST #32B
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3850
Mailing Address - Country:US
Mailing Address - Phone:781-395-7841
Mailing Address - Fax:781-395-0095
Practice Address - Street 1:92 HIGH ST #32B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3850
Practice Address - Country:US
Practice Address - Phone:781-395-7841
Practice Address - Fax:781-395-0095
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics