Provider Demographics
NPI:1447366513
Name:COOPER, GARY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:COOPER
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 1:420 S CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3931
Mailing Address - Country:US
Mailing Address - Phone:865-457-1496
Mailing Address - Fax:865-457-4336
Practice Address - Street 1:420 S CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3931
Practice Address - Country:US
Practice Address - Phone:865-457-1496
Practice Address - Fax:865-457-4336
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist