MEDICARE: COOPERATING DENTAL MANAGEMENT GROUP INC.

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1629294640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPERATING DENTAL MANAGEMENT GROUP INC.

Provider Business Mailing Address
First Line	:	1685 LOCKBOURNE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1476
Country	:	US
Telephone Number	:	614-444-9849
Fax Number	:	614-444-0811

Provider Business Practice Location Address
First Line	:	1685 LOCKBOURNE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1476
Country	:	US
Telephone Number	:	614-444-9849
Fax Number	:	614-444-0811

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DARIUS A TALEBI
Credential	:
Telephone Number	:	614-444-9849

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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