Provider Demographics
NPI:1093920761
Name:COOLEY, CHARLES A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:COOLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1832
Mailing Address - Country:US
Mailing Address - Phone:903-592-6535
Mailing Address - Fax:
Practice Address - Street 1:601 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1832
Practice Address - Country:US
Practice Address - Phone:903-592-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY201047746OtherDELTA DENTAL
KY201047746OtherAETNA
CA201047746OtherBC LIFE & HEALTH DENTAL SERVICES
NC201047746OtherCOVENTRY HEALTH CARE
NE201047746OtherAMERITAS LIFE
MA201047746OtherSUN LIFE AND HEALTH INS.
UT201047746OtherUNITED HEALTHCARE DENTAL
MO201047746OtherGEHA STATE OF TX DENTAL CHOICE
PA201047746OtherUNITED CONCORDIA
KY201047746OtherHUMANA
CA201047746OtherLIBERTY DENTAL
IA201047746OtherASSURANT
MI201047746OtherDELTA DENTAL OF MI, OH, IN
OK201047746OtherBLUE CROSS BLUE SHIELD OF OKLAHOMA
TN201047746OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
CA201047746OtherDELTA DENTAL OF CALIFORNIA
NC20104776OtherPRIMARY CARE PHYSICIANS
IL20104776OtherDENTAL NETWORK OF AMERICA
TX201047746OtherMETLIFE DENTAL
TX201047746OtherFISERVHEALTH
201047746OtherCIGNA
CA201047746OtherUNICARE
TX201047746OtherUMR
IA201047746OtherDELTA DENTAL OF IOWA
AR201047746OtherDELTA DENTAL OF ARKANSAS
AL201047746OtherBLUE CROSS BLUE SHIELD OF ALABAMA
MN201047746OtherDELTA DENTAL
OK201047746OtherOLD SURRETY LIFE
TN201047746OtherDELTA DENTAL OF TENNESSEE
WA201047746OtherSTERLING LIFE INS. CO.
KS201047746OtherDELTA DENTAL
TX201047746OtherBLUE CROSS BLUE SHIELD FEDERAL
IL201047746OtherLINECO
KY201047746OtherDELTA DENTAL OF KENTUCKY
TX20104776OtherHEALTHFIRST TPA
VA20104776OtherGENWORTH FINANCIAL
GA201047746OtherDELTA DENTAL OF GEORGIA
IA201047746OtherPRINCIPAL LIFE
FL201047746OtherCOMPBENEFITS
IL201047746OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
TX20104776OtherWEB TPA
NJ201047746OtherDELTA DENTAL
WA201047746OtherGUARDIAN
201047746OtherCENTRAL STATES SOUTHEAST AND SOUTHWEST
CA201047746OtherSAFEHEALTH LIFE INS.
TX88D834OtherBLUE CROSS BLUE SHIELD