Provider Demographics
NPI:1851659601
Name:COONER DENTAL
Entity Type:Organization
Organization Name:COONER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:COONER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-221-6218
Mailing Address - Street 1:1608 HIGHWAY 78 W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3668
Mailing Address - Country:US
Mailing Address - Phone:205-221-6218
Mailing Address - Fax:
Practice Address - Street 1:1608 HIGHWAY 78 W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3668
Practice Address - Country:US
Practice Address - Phone:205-221-6218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3662261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental