Provider Demographics
NPI:1528671971
Name:COOPER, ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 S MCCORMICK PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-7928
Mailing Address - Country:US
Mailing Address - Phone:208-371-7081
Mailing Address - Fax:
Practice Address - Street 1:3999 N GLOSTER ST STE D
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0950
Practice Address - Country:US
Practice Address - Phone:662-778-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23305122300000X
MS4159-20122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist