MEDICARE: DR. ROBERT DOUGLAS COOPER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D13076	MN

General Provider Information

NPI Number	:	1376800102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DOUGLAS COOPER DDS

Provider Business Mailing Address
First Line	:	12888 187TH CIR NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-1112
Country	:	US
Telephone Number	:	763-389-3320
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 S RUM RIVER DR
Second Line	:
City	:	PRINCETON
State	:	MN
Zip	:	55371-2016
Country	:	US
Telephone Number	:	763-389-3320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	01/07/2026

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