Healthcare Provider Details

I. General information

NPI: 1215155155
Provider Name (Legal Business Name): CALVIN DUKE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 PAOLI PIKE SUITE 202
FLOYDS KNOBS IN
47119-9696
US

IV. Provider business mailing address

4801 PAOLI PIKE SUITE 202
FLOYDS KNOBS IN
47119-9696
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12010338A
License Number StateIN

VIII. Authorized Official

Name: DR. CHRISTOPHER COOK
Title or Position: PRESIDENT
Credential: DMD
Phone: 812-923-1500