Provider Demographics
NPI:1679633408
Name:JAMES M COOPER DDS PC
Entity Type:Organization
Organization Name:JAMES M COOPER DDS PC
Other - Org Name:NT MOISIDES & COOPER DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-881-8404
Mailing Address - Street 1:19639 MACK AVENUE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2535
Mailing Address - Country:US
Mailing Address - Phone:313-881-8404
Mailing Address - Fax:313-881-8656
Practice Address - Street 1:19639 MACK AVENUE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2535
Practice Address - Country:US
Practice Address - Phone:313-881-8404
Practice Address - Fax:313-881-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty