Provider Demographics
NPI:1710498050
Name:COOLEY, REGGIE (DDS)
Entity type:Individual
Prefix:DR
First Name:REGGIE
Middle Name:
Last Name:COOLEY
Suffix:
Gender:M
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:PO BOX 18941
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-0941
Mailing Address - Country:US
Mailing Address - Phone:405-476-2265
Mailing Address - Fax:
Practice Address - Street 1:503 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4655
Practice Address - Country:US
Practice Address - Phone:580-749-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK69551223G0001X
TN00000121241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice