Organization
C&C ORTHO PC
Active
Organization
C&C ORTHO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN S. COOPER DDS (PRESIDENT)
(918) 488-8889
Entity
Organization
Contact information
Practice address
3916 E 91ST ST, TULSA, OK 74137-3602
(918) 488-8889
Mailing address
3916 E 91ST ST, TULSA, OK 74137-3602
(918) 488-8889
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
4919
OK
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5152
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447478698
INDIVIDUAL NPI #: 1447478698 - BRENDA CHOCKLEY, DDS
OK
Enumeration date
11/10/2009
Last updated
11/10/2009
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