Provider Demographics
NPI:1699036137
Name:JORDAN COOPER DDS PLLC
Entity Type:Organization
Organization Name:JORDAN COOPER DDS PLLC
Other - Org Name:COMMUNITY GENERAL AND IMPLANT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-231-9928
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0217
Mailing Address - Country:US
Mailing Address - Phone:479-419-5959
Mailing Address - Fax:479-935-9248
Practice Address - Street 1:1333 ARAPAHO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6936
Practice Address - Country:US
Practice Address - Phone:479-419-5959
Practice Address - Fax:479-935-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty