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General NPI Number Information
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NPI Number | 1649380452
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Entity Type | Organization
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Legal Business Name | ROCKVILLE ROAD DENTISTRY
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 6355 ROCKVILLE ROAD
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City | INDIANAPOLIS
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State | IN
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Zip | 46214
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Country | US
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Telephone | 317-227-0581
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Fax | 317-227-0820
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Provider Business Mailing Address
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Address Line | 6355 ROCKVILLE ROAD
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City | INDIANAPOLIS
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State | IN
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Zip | 46214
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Country | US
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Telephone | 317-227-0581
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Fax | 317-227-0820
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRIEDA COOKE
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Credential | DO
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Telephone | 317-227-0881
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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 | 12009952
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License Number State | IN
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