Healthcare Provider Details

I. General information

NPI: 1841560794
Provider Name (Legal Business Name): J CRAIG COOK DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 STATE ST SUITE # 407
NEW ALBANY IN
47150-4929
US

IV. Provider business mailing address

1919 STATE ST SUITE # 407
NEW ALBANY IN
47150-4929
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-9100
  • Fax: 812-945-9105
Mailing address:
  • Phone: 812-945-9100
  • Fax: 812-945-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12009951
License Number StateIN

VIII. Authorized Official

Name: DR. JOHN CRAIG COOK
Title or Position: ORAL & MAXILLOFACIAL SURGEON
Credential: DDS
Phone: 812-945-9100