Provider Demographics
NPI:1598107146
Name:COOGLER, AMY DOWNS (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DOWNS
Last Name:COOGLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:DOWNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2376 SOMERSET VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4488
Mailing Address - Country:US
Mailing Address - Phone:662-416-0464
Mailing Address - Fax:662-728-2056
Practice Address - Street 1:400 S SECOND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829
Practice Address - Country:US
Practice Address - Phone:662-728-1999
Practice Address - Fax:662-728-2056
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3641-12122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist