Provider Demographics
NPI:1972664811
Name:COOPER, JEFFREY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
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 1:114 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5013
Mailing Address - Country:US
Mailing Address - Phone:507-474-1355
Mailing Address - Fax:
Practice Address - Street 1:720 E HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5300
Practice Address - Country:US
Practice Address - Phone:507-452-9453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND98991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice