Provider Demographics
NPI:1427503135
Name:COOPER, RYAN ROBERT WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ROBERT WILLIAM
Last Name:COOPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1646
Mailing Address - Country:US
Mailing Address - Phone:651-459-2387
Mailing Address - Fax:651-459-3259
Practice Address - Street 1:1590 HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MN
Practice Address - Zip Code:55055-1646
Practice Address - Country:US
Practice Address - Phone:651-459-2387
Practice Address - Fax:651-459-3259
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist