Provider Demographics
NPI:1790463339
Name:COOPER, JARED (DDS)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
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 1:2915 E MOORE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4975
Mailing Address - Country:US
Mailing Address - Phone:501-268-5115
Mailing Address - Fax:501-268-2152
Practice Address - Street 1:2915 E MOORE AVE STE 1
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4975
Practice Address - Country:US
Practice Address - Phone:501-268-5115
Practice Address - Fax:501-268-2152
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist