Provider Demographics
NPI:1982817839
Name:DR. COOPER2 GENTLE DENTAL ASSOC., LTD.
Entity Type:Organization
Organization Name:DR. COOPER2 GENTLE DENTAL ASSOC., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-244-4000
Mailing Address - Street 1:5101 WASHINGTON ST
Mailing Address - Street 2:SUITE 2V
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5916
Mailing Address - Country:US
Mailing Address - Phone:847-244-4000
Mailing Address - Fax:847-244-5911
Practice Address - Street 1:5101 WASHINGTON ST
Practice Address - Street 2:SUITE 2V
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5916
Practice Address - Country:US
Practice Address - Phone:847-244-4000
Practice Address - Fax:847-244-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty