Provider Demographics
NPI:1437223849
Name:COOPER, JERIL RANSOM IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERIL
Middle Name:RANSOM
Last Name:COOPER
Suffix:IV
Gender:M
Credentials:DMD
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Mailing Address - Street 1:4610 BRAINERD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3836
Mailing Address - Country:US
Mailing Address - Phone:423-622-4173
Mailing Address - Fax:423-629-9889
Practice Address - Street 1:4610 BRAINERD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3836
Practice Address - Country:US
Practice Address - Phone:423-622-4173
Practice Address - Fax:423-629-9889
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2013-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNDS84681223X0400X
GADN0127661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics