Individual
DR. CHARLES ROBERT COOLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2630 S EAGLE RD, MERIDIAN, ID 83642-6704
(208) 888-0625
(208) 888-9128
Mailing address
2630 S EAGLE RD, MERIDIAN, ID 83642-6704
(208) 888-0625
(208) 888-9128
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-5153
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D5153
STATE LICENSE NUMBER
ID
Enumeration date
06/12/2020
Last updated
06/12/2020
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