Provider Demographics
NPI:1972342285
Name:COOPER, TAYLOR JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JEAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BEL AIR LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6992
Mailing Address - Country:US
Mailing Address - Phone:507-288-1188
Mailing Address - Fax:
Practice Address - Street 1:1011 BEL AIR LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6992
Practice Address - Country:US
Practice Address - Phone:507-288-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice