Provider Demographics
NPI:1487728614
Name:TODD COOPER, DDS, TYSON TEEPLES, DMD, MD, RYAN TOPONCE, DMD, PS.
Entity type:Organization
Organization Name:TODD COOPER, DDS, TYSON TEEPLES, DMD, MD, RYAN TOPONCE, DMD, PS.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-783-7600
Mailing Address - Street 1:512 N YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7806
Mailing Address - Country:US
Mailing Address - Phone:509-783-7600
Mailing Address - Fax:509-783-0774
Practice Address - Street 1:512 N YOUNG ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7806
Practice Address - Country:US
Practice Address - Phone:509-783-7600
Practice Address - Fax:509-783-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA62931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5042361Medicaid
WA5017660Medicaid
WA5017652Medicaid
WA5014337Medicaid
WAU32796Medicare UPIN
WA319200900Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WA5042361Medicaid
WAAB37487Medicare ID - Type UnspecifiedDR TODD COOPER
WA319200902Medicare ID - Type UnspecifiedDR JON CRAWFORD
WA5014337Medicaid
WAU50124Medicare UPIN