Provider Demographics
NPI:1710090758
Name:COOPER, BRUCE TYRE (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TYRE
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:12814 WILLOW CTR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-3038
Mailing Address - Country:US
Mailing Address - Phone:281-453-5300
Mailing Address - Fax:281-453-5302
Practice Address - Street 1:12814 WILLOW CTR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-3038
Practice Address - Country:US
Practice Address - Phone:281-453-5300
Practice Address - Fax:281-453-5302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129531223S0112X
TXH2317204E00000X, 207Q00000X, 208200000X
MI084143207Q00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery