Provider Demographics
NPI:1528123767
Name:COONEY, DOROTHY JANE (DDS)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:JANE
Last Name:COONEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:COONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:700 W FAIRCHILD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-446-8114
Mailing Address - Fax:217-446-5254
Practice Address - Street 1:700 W FAIRCHILD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-446-8114
Practice Address - Fax:217-446-5254
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AC1822154OtherDEA