Provider Demographics
NPI:1760438410
Name:COOPER, BARRY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:C
Last Name:COOPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1932
Mailing Address - Country:US
Mailing Address - Phone:516-239-4544
Mailing Address - Fax:516-239-4557
Practice Address - Street 1:1315A BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2115
Practice Address - Country:US
Practice Address - Phone:516-239-4544
Practice Address - Fax:516-239-4557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice