Provider Demographics
NPI:1912071770
Name:COOPER JENKINS, MARYLIN MARIE (DDS)
Entity type:Individual
Prefix:MRS
First Name:MARYLIN
Middle Name:MARIE
Last Name:COOPER JENKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARYLIN
Other - Middle Name:MARIE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:700 N KING STREET
Mailing Address - Street 2:
Mailing Address - City:SEQUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155
Mailing Address - Country:US
Mailing Address - Phone:830-379-0664
Mailing Address - Fax:830-379-3003
Practice Address - Street 1:700 N KING STREET
Practice Address - Street 2:
Practice Address - City:SEQUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-379-0664
Practice Address - Fax:830-379-3003
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16819OtherTEXAS STATE DENTAL BOARD