Individual
DR. JACK DEAN COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
705 N 17TH AVE, ASHLAND, NE 68003
(402) 944-3305
(402) 944-3305
Mailing address
705 N 17TH AVE, ASHLAND, NE 68003
(402) 944-3305
(402) 944-3305
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4005
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47064558902
—
NE
Enumeration date
10/03/2006
Last updated
07/08/2007
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