Provider Demographics
NPI:1184724650
Name:COOPER, PRESTON (DDS)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:
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 1:1215 MILITARY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-315-5574
Mailing Address - Fax:501-315-5579
Practice Address - Street 1:1215 MILITARY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-315-5574
Practice Address - Fax:501-315-5579
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist