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General NPI Number Information
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NPI Number | 1356613277
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Entity Type | Organization
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Legal Business Name | LOUISVILLE ENDODONTICS
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 7980 NEW LAGRANGE ROAD SUITE 2
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City | LOUISVILLE
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State | KY
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Zip | 40222
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Country | US
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Telephone | 502-412-3636
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Fax | 502-412-2827
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Provider Business Mailing Address
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Address Line | 7980 NEW LAGRANGE ROAD SUITE 2
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City | LOUISVILLE
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State | KY
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Zip | 40222
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Country | US
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Telephone | 502-412-3636
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Fax | 502-412-2827
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER JOHN COOK
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Credential | DMD
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Telephone | 502-412-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 7082
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License Number State | KY
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