Mark Cooper, D.D.S.
Individual provider Active NPI Dentist · Chester, NY
NPI 1730359449 · NPPES record last updated Mar 10, 2008
Key facts
- NPI
- 1730359449
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0391931 (NY)
- Practice address
- 11 West Ave
Route 94
Chester, NY 10918-3501 - Phone
- (845) 469-7040
- NPI assigned
- Mar 10, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 0391931 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Cooper, DDS, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0391931 | NY | Yes |
Addresses
Primary practice location
11 West Ave
Route 94
Chester, NY 10918-3501
Mailing address
11 West Ave
Route 94
Chester, NY 10918-3501
Phone (845) 469-7040
Other providers in Chester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2008. 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.