Provider Demographics
NPI:1871941153
Name:KOOPS, JED M (DMD)
Entity type:Individual
Prefix:
First Name:JED
Middle Name:M
Last Name:KOOPS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2441
Mailing Address - Country:US
Mailing Address - Phone:216-459-7021
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL STE 515
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4466
Practice Address - Country:US
Practice Address - Phone:216-464-2448
Practice Address - Fax:216-292-2532
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.247681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice