Charles Cooper Jr.
Individual provider Active NPI Dentist · Cushing, OK
NPI 1104222173 · NPPES record last updated Nov 18, 2014
Key facts
- NPI
- 1104222173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5163 (OK)
- Practice address
- 3200 S Kings Hwy
Cushing, OK 74023-5355 - Phone
- (918) 225-3336
- Fax
- (918) 223-2937
- NPI assigned
- Nov 18, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5163 | OK | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5163 | OK | Yes |
Addresses
Primary practice location
3200 S Kings Hwy
Cushing, OK 74023-5355
Mailing address
3200 S Kings Hwy
Cushing, OK 74023-5355
Phone (918) 225-3336
Other providers in Cushing, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.