Provider Demographics
NPI:1568511699
Name:COOPER, ROBERT BRUCE (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRUCE
Last Name:COOPER
Suffix:
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 1:200 N 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463
Mailing Address - Country:US
Mailing Address - Phone:318-335-0530
Mailing Address - Fax:318-335-4326
Practice Address - Street 1:200 N 15TH STREET
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463
Practice Address - Country:US
Practice Address - Phone:318-335-0530
Practice Address - Fax:318-335-4326
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1831301Medicaid