Healthcare Provider Details

I. General information

NPI: 1881629194
Provider Name (Legal Business Name): MATTHEW D COOPER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E CENTER ST
BELDING MI
48809-2030
US

IV. Provider business mailing address

306 E CENTER ST
BELDING MI
48809-2030
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-1145
  • Fax: 616-794-1059
Mailing address:
  • Phone: 616-794-1145
  • Fax: 616-794-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: