| Doctor Name: | MR. EDWARD JERROLD COOPER |
| NPI Number: | 1952551848 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.D |
| License Number: | DT-DO-916801 |
| Business Practice Address: | 4645 South East 85th Ave. Portland, OR - 97266 |
| Business Phone Number: | 5037753797 |
| Business Fax Number: | |
| Mailing Address: | 4645 South East 85th Ave., PORTLAND |
| State: | OR |
| Postal Code: | 97266 |
| Phone Number: | 5037753797 |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2008 |
| NPI Last Update Date: | 09/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DT-DO-916801 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |