# JACK D COOPER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891240495
- **Authorized official:** KAYLA C KOBS (OFFICE MANAGER)
- **Authorized official phone:** (402) 944-3305

## Contact information

- **Practice address:** 705 N 17TH AVE, ASHLAND, NE 68003-1209
- **Practice address phone:** (402) 944-3305
- **Practice address fax:** (402) 944-7611
- **Mailing address:** 705 N 17TH AVE, ASHLAND, NE 68003-1209
- **Mailing address phone:** (402) 944-3305
- **Mailing address fax:** (402) 944-7611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4005 | NE | Yes |

## Other

- **Enumeration date:** 08/24/2016
- **Last updated:** 08/24/2016