Provider Demographics
NPI:1689051310
Name:COOPER, ADA (DDS)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4401
Mailing Address - Country:US
Mailing Address - Phone:212-838-2760
Mailing Address - Fax:212-838-6614
Practice Address - Street 1:417 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4401
Practice Address - Country:US
Practice Address - Phone:212-838-2760
Practice Address - Fax:212-838-6614
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050089-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist