Provider Demographics
NPI:1376625442
Name:COOL, JAMES G (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:COOL
Suffix:
Gender:M
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:PO BOX 849
Mailing Address - Street 2:610 W 2ND STREET
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156
Mailing Address - Country:US
Mailing Address - Phone:509-447-3105
Mailing Address - Fax:509-447-5661
Practice Address - Street 1:610 W 2ND STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156
Practice Address - Country:US
Practice Address - Phone:509-447-3105
Practice Address - Fax:509-447-5661
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5015318Medicaid