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General NPI Number Information
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NPI Number | 1528055951
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Entity Type | Individual
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Provider Name | NORMAN BLAINE COOK D.D.S., M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 1121 W MICHIGAN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5211
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Country | US
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Telephone | 317-274-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 W MICHIGAN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5211
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Country | US
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Telephone | 317-274-5328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12009644A
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License Number State | IN
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