1982817839 NPI number — DR. COOPER2 GENTLE DENTAL ASSOC., LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982817839 NPI number — DR. COOPER2 GENTLE DENTAL ASSOC., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. COOPER2 GENTLE DENTAL ASSOC., LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1982817839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5101 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 2V
Provider Business Mailing Address City Name:
GURNEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60031-5916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-244-4000
Provider Business Mailing Address Fax Number:
847-244-5911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5101 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 2V
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-5916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-244-4000
Provider Business Practice Location Address Fax Number:
847-244-5911
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
847-244-4000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com