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General NPI Number Information
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NPI Number | 1386971406
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Entity Type | Organization
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Legal Business Name | C&C ORTHO PC
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 3916 E 91ST ST
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City | TULSA
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State | OK
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Zip | 74137-3602
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Country | US
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Telephone | 918-488-8889
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Fax |
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Provider Business Mailing Address
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Address Line | 3916 E 91ST ST
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City | TULSA
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State | OK
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Zip | 74137-3602
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Country | US
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Telephone | 918-488-8889
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN S. COOPER
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Credential | DDS
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Telephone | 918-488-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4919
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 5152
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License Number State | OK
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