Provider Demographics
NPI:1881329142
Name:COOPER, EDWARD PERRY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PERRY
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 N MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2039
Mailing Address - Country:US
Mailing Address - Phone:501-609-6638
Mailing Address - Fax:
Practice Address - Street 1:932 N GASKILL ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-8903
Practice Address - Country:US
Practice Address - Phone:870-448-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR46291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice