| Doctor Name: | MR. JOHN W COOPER |
| NPI Number: | 1083958011 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | A.A.S., L.D. |
| License Number: | DT-D-0501891 |
| Business Practice Address: | 3949 Shasta Way Klamath Falls, OR - 97603 |
| Business Phone Number: | 5418840292 |
| Business Fax Number: | 8846192541 |
| Mailing Address: | 3949 Shasta Way, KLAMATH FALLS |
| State: | OR |
| Postal Code: | 97603 |
| Phone Number: | 5418840292 |
| Fax Number: | 5418846192 |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 11/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DT-D-0501891 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |