Individual
DR. JORDAN TODD COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
308 N JAMES ST, JACKSONVILLE, AR 72076-4018
(501) 982-7547
(501) 985-8421
Mailing address
308 N JAMES ST, JACKSONVILLE, AR 72076-4018
(501) 982-7547
(501) 985-8421
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3535
AR
1223G0001X
General Practice Dentistry
3565
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164868608
—
AR
01
—
1874975
UNITED CONCORDIA
AR
01
—
5Y893
BLUE CROSS BLUE SHIELD
AR
Enumeration date
12/13/2006
Last updated
09/23/2021
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