Provider Demographics
NPI:1114064649
Name:COOPER, GORDON SCOTT (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:SCOTT
Last Name:COOPER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 GRAND RIDGE DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1295
Mailing Address - Country:US
Mailing Address - Phone:714-925-6284
Mailing Address - Fax:
Practice Address - Street 1:2708 SANTIAM HWY SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5251
Practice Address - Country:US
Practice Address - Phone:541-418-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics