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NPI Code Detail

MEDICARE: CRAIG DOUGLAS COOPER DDS

MEDICARE: CRAIG DOUGLAS COOPER DDS
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
1122300000XDentist12007098AIN

General Provider Information

NPI Number : 1740448513
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG DOUGLAS COOPER DDS
Provider Business Mailing Address
First Line : 7265 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2021
Country : US
Telephone Number : 317-577-2450
Fax Number :
Provider Business Practice Location Address
First Line : 7265 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2021
Country : US
Telephone Number : 317-577-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2008
Last Update Date : 05/29/2008

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Directions to “ CRAIG DOUGLAS COOPER DDS” Practice Location

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