Provider Demographics
NPI:1740594191
Name:COOPER, NAOMI DAKOTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:DAKOTA
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAKOTA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2213 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3607
Mailing Address - Country:US
Mailing Address - Phone:817-354-9999
Mailing Address - Fax:817-354-1301
Practice Address - Street 1:2213 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3607
Practice Address - Country:US
Practice Address - Phone:817-354-9999
Practice Address - Fax:817-354-1301
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice