Provider Demographics
NPI:1346497492
Name:LESLIE P COONER DDS PA
Entity Type:Organization
Organization Name:LESLIE P COONER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:COONER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-227-6226
Mailing Address - Street 1:10220 W MARKHAM ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2189
Mailing Address - Country:US
Mailing Address - Phone:501-227-6226
Mailing Address - Fax:501-227-6295
Practice Address - Street 1:10220 W MARKHAM ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2189
Practice Address - Country:US
Practice Address - Phone:501-227-6226
Practice Address - Fax:501-227-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2805261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental