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NPI Code Detail

MEDICARE: DR. NORMAN BLAINE COOK D.D.S., M.S.D.

MEDICARE: DR. NORMAN BLAINE COOK D.D.S., M.S.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry12009644AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17874OTHERNEBC/BS

General Provider Information

NPI Number : 1528055951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NORMAN BLAINE COOK D.D.S., M.S.D.
Provider Business Mailing Address
First Line : 1121 W MICHIGAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5211
Country : US
Telephone Number : 317-274-5328
Fax Number :
Provider Business Practice Location Address
First Line : 1121 W MICHIGAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5211
Country : US
Telephone Number : 317-274-5328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 09/11/2009

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