Individual
JERRY EDWARD COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
708 1ST AVE S, ALTOONA, IA 50009-1717
(515) 967-6611
Mailing address
5437 NW 78TH CT, JOHNSTON, IA 50131-1801
(515) 334-9501
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7506
IA
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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