David Fenton Cooley, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

096850 Issued in MI

Practice address

5108 Lovers LN
Suite D
Portage, MI 49002-1558

Phone

(269) 345-1021

Fax

(269) 345-0948

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 13, 2010 through Dec 13, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952440356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 LOVERS LN",
            "address_2": "SUITE D",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021558",
            "telephone_number": "269-345-1021",
            "fax_number": "269-345-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5108 LOVERS LN",
            "address_2": "SUITE D",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021558",
            "telephone_number": "269-345-1021",
            "fax_number": "269-345-0948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "DAVID",
        "middle_name": "FENTON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "096850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN PROVIDER ID",
            "identifier": "096850",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Compassus Aah of Michigan II, LLC
• Comprehensive Neuropsychological Services PC
• Jane Ann Connon
• Conscious Choices Counseling, PLC
• Muhammed S Conteh
• Grace Cooley
• Alyssa Coombs
• Graydon H. Coon, DDS
• Marissa Cooney, LMSW
• Joe Lee Cooper Jr., LLMSW

• General Practice Dentistry in Portage, MI
• Providers in Portage, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.