Provider Demographics
NPI:1811254196
Name:COOPER, RACHEL BRYN VAUGHAN (DDS, MA, MS)
Entity type:Individual
Prefix:DR
First Name:RACHEL BRYN
Middle Name:VAUGHAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS, MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 WASHINGTON AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007
Mailing Address - Country:US
Mailing Address - Phone:832-925-8721
Mailing Address - Fax:
Practice Address - Street 1:4525 WASHINGTON AVE
Practice Address - Street 2:STE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007
Practice Address - Country:US
Practice Address - Phone:832-925-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001666122300000X
TX295561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist