Provider Demographics
NPI:1932430980
Name:COOPER, JOEL D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:COOPER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 MOORES LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2905
Mailing Address - Country:US
Mailing Address - Phone:615-377-7777
Mailing Address - Fax:615-661-4527
Practice Address - Street 1:7004 MOORES LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2905
Practice Address - Country:US
Practice Address - Phone:615-377-7777
Practice Address - Fax:615-661-4527
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-36811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics