Provider Demographics
NPI:1578766358
Name:COOPER, MITCHELL RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:RICHARD
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 1:7900 E THOMPSON PEAK PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7400
Mailing Address - Country:US
Mailing Address - Phone:480-994-4327
Mailing Address - Fax:
Practice Address - Street 1:7900 E THOMPSON PEAK PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7400
Practice Address - Country:US
Practice Address - Phone:480-994-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice