Provider Demographics
NPI:1770690133
Name:COOLEY, GARY GENE
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:GENE
Last Name:COOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 FACTORIA BLVD SE STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1262
Mailing Address - Country:US
Mailing Address - Phone:425-747-7000
Mailing Address - Fax:
Practice Address - Street 1:4100 FACTORIA BLVD SE STE C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1262
Practice Address - Country:US
Practice Address - Phone:425-747-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice