Provider Demographics
NPI:1881629194
Name:COOPER, MATTHEW D (DDS)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
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 1:306 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-2030
Mailing Address - Country:US
Mailing Address - Phone:616-794-1145
Mailing Address - Fax:616-794-1059
Practice Address - Street 1:306 E CENTER ST
Practice Address - Street 2:
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-2030
Practice Address - Country:US
Practice Address - Phone:616-794-1145
Practice Address - Fax:616-794-1059
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist