Individual
COOPER PASQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6268 KNIGHT PL APT 2, FORT RILEY, KS 66442-3325
(910) 643-1607
Mailing address
6268 KNIGHT PL APT 2, FORT RILEY, KS 66442-3325
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
7195
OK
Other
Enumeration date
08/15/2019
Last updated
04/07/2023
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