1881629194 NPI number — MR. MATTHEW D COOPER DDS

Table of content: MR. MATTHEW D COOPER DDS (NPI 1881629194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881629194 NPI number — MR. MATTHEW D COOPER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
MATTHEW
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881629194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 E CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELDING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48809-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-794-1145
Provider Business Mailing Address Fax Number:
616-794-1059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 E CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELDING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48809-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-794-1145
Provider Business Practice Location Address Fax Number:
616-794-1059
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901016790 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)