Provider Demographics
NPI:1699864850
Name:COOPER, ALAN DEWAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DEWAYNE
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 1:207 SW 156TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2561
Mailing Address - Country:US
Mailing Address - Phone:206-244-4545
Mailing Address - Fax:206-244-0336
Practice Address - Street 1:207 SW 156TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2561
Practice Address - Country:US
Practice Address - Phone:206-244-4545
Practice Address - Fax:206-244-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000088021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice