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General NPI Number Information
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NPI Number | 1962571802
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Entity Type | Individual
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Provider Name | SEAN LELAND COOK D.D.S.,M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8011 ROBIN HILL RD
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City | NEWBURGH
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State | IN
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Zip | 47630-3083
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Country | US
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Telephone | 812-853-2977
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Fax | 812-853-1705
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Provider Business Mailing Address
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Address Line | 8011 ROBIN HILL RD
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City | NEWBURGH
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State | IN
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Zip | 47630-3083
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Country | US
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Telephone | 812-853-2977
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Fax | 812-853-1705
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12010543A
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License Number State | IN
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