Provider Demographics
NPI:1265509319
Name:COOPER, JOHN E II (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:COOPER
Suffix:II
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 1:11126 WEST WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363
Mailing Address - Country:US
Mailing Address - Phone:823-933-3684
Mailing Address - Fax:623-933-1226
Practice Address - Street 1:11126 WEST WISCONSIN AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363
Practice Address - Country:US
Practice Address - Phone:823-933-3684
Practice Address - Fax:623-933-1226
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice