Bruce E Cooper, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00006116 Issued in WA

Practice address

1105 4TH Ave E
Ste a
Olympia, WA 98506-4018

Phone

(360) 357-8075

Fax

(360) 357-3842

NPI assigned

Jun 9, 2005

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Joseph Moss DDS & Tyler Tebay DMD PS

  • General Practice Dentistry
  • Olympia, WA
  • NPI 1912167248
  NPD (past)

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435276800000",
    "number": "1104820901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 4TH AVE E",
            "address_2": "STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985064018",
            "telephone_number": "360-357-8075",
            "fax_number": "360-357-3842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 4TH AVE E",
            "address_2": "STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985064018",
            "telephone_number": "360-357-8075",
            "fax_number": "360-357-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "BRUCE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2015-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00006116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5005459",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanele M Cook, ARNP
• Shaun Keith Coombs, OD
• Katrina Coons
• Nenita D Coons, RN
• Jaime Lee Cooper-Carson
• Hasseltine Elizabeth Cooper, D.O.
• Joanne Barry Cooper, LMP
• Samuel E. Coor, DO
• Copper Moon Massage Therapy
• Coppin & Lane, PLLC

• General Practice Dentistry in Olympia, WA
• Providers in Olympia, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; 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.