Provider Demographics
NPI:1538172929
Name:COOPER, ELIZABETH JOAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JOAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1302
Mailing Address - Country:US
Mailing Address - Phone:651-699-1547
Mailing Address - Fax:651-690-0164
Practice Address - Street 1:757 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1302
Practice Address - Country:US
Practice Address - Phone:651-699-1547
Practice Address - Fax:651-690-0164
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist