Charles Robert Cooley, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D-5153 Issued in ID

Practice address

2630 S Eagle Rd
Meridian, ID 83642-6704

Phone

(208) 888-0625

Fax

(208) 888-9128

NPI assigned

Jun 12, 2020

Last updated

Jun 12, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stone Creek Dental

  • General Practice Dentistry
  • Meridian, ID
  • NPI 1568621886
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591920000000",
    "number": "1063037315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426704",
            "telephone_number": "208-888-0625",
            "fax_number": "208-888-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426704",
            "telephone_number": "208-888-0625",
            "fax_number": "208-888-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "CHARLES",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-12",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D5153",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@scdsmiles.com",
            "affiliation": "N",
            "endpointDescription": "company email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2630 S Eagle Rd",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836426704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Continuum Care Providers of Idaho, LLC
• Alyssa Elizabeth Cook, M.A., CCC-SLP
• Hannah Frayne Emanuel Cook, RN
• Jennifer Kaye Cook, APRN
• Jessa Cook, ATL, ATC
• Kaitlin Cooley, FNP-C
• Weslie Cooley, CPNP-PC
• Christine Cooper
• Cypress April Cooper, NP
• Trace Cooper, DO STUDENT

• Dentist in Meridian, ID
• Providers in Meridian, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.