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General NPI Number Information
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NPI Number | 1356620702
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Entity Type | Organization
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Legal Business Name | JORDAN TODD COOPER DDS PA
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 308 N JAMES ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4018
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Country | US
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Telephone | 501-982-7547
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Fax | 501-985-8421
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Provider Business Mailing Address
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Address Line | 308 N JAMES ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4018
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Country | US
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Telephone | 501-982-7547
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Fax | 501-985-8421
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORDAN TODD COOPER
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Credential | DDS
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Telephone | 501-982-7547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3565
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License Number State | AR
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