Provider Demographics
NPI:1578734752
Name:COOPER, JOEL B (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:COOPER
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 1:43 S LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2804
Mailing Address - Country:US
Mailing Address - Phone:610-623-7610
Mailing Address - Fax:610-623-0023
Practice Address - Street 1:43 S LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2804
Practice Address - Country:US
Practice Address - Phone:610-623-7610
Practice Address - Fax:610-623-0023
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018213L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice