Provider Demographics
NPI:1851412811
Name:COOPER, PROVENCE & HALEY, PC
Entity Type:Organization
Organization Name:COOPER, PROVENCE & HALEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-320-1392
Mailing Address - Street 1:502 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2016
Mailing Address - Country:US
Mailing Address - Phone:615-446-9669
Mailing Address - Fax:615-446-9661
Practice Address - Street 1:207 23RD AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1501
Practice Address - Country:US
Practice Address - Phone:615-320-1392
Practice Address - Fax:615-329-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS30321223S0112X
TNDS72191223S0112X
TNDS46071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1982601829OtherNPI TIMOTHY D. PROVENCE
TN2009819OtherBCBST LINDSEY W. COOPER
TN4607OtherLICENSE TIMOTHY PROVENCE
TN7219OtherLICENSE SPENCER HALEY
TN2006315OtherBCBST TIMOTHY D PROVENCE
TN1043218670OtherNPI LINDSEY W. COOPER,
TN1275531972OtherNPI - SPENCER A HALEY
TN3032OtherLICENSE # LINDSEY W. COOP
TN3141185OtherBCBST SPENCER A HALEY
TN3141185OtherBCBST SPENCER A HALEY
TN2009819OtherBCBST LINDSEY W. COOPER
TN7219OtherLICENSE SPENCER HALEY
TN1982601829OtherNPI TIMOTHY D. PROVENCE
TN3032OtherLICENSE # LINDSEY W. COOP
TNT74297Medicare UPIN
TN3223870Medicare ID - Type UnspecifiedLINDSEY W. COOPER, SR