Provider Demographics
NPI:1710291810
Name:COONEY, CAREY EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:EDWARD
Last Name:COONEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3031
Mailing Address - Country:US
Mailing Address - Phone:541-342-6160
Mailing Address - Fax:541-342-2723
Practice Address - Street 1:280 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3031
Practice Address - Country:US
Practice Address - Phone:541-342-6160
Practice Address - Fax:541-342-2723
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice