Provider Demographics
NPI:1336693746
Name:COOPER, SARA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:JEAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 SHINGLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430
Mailing Address - Country:US
Mailing Address - Phone:612-405-4839
Mailing Address - Fax:
Practice Address - Street 1:1090 SHINGLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430
Practice Address - Country:US
Practice Address - Phone:612-405-4839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist