Provider Demographics
NPI:1689043085
Name:COOK PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:COOK PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:LELAND
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:812-853-2977
Mailing Address - Street 1:8011 ROBIN HILL RD
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3083
Mailing Address - Country:US
Mailing Address - Phone:812-853-2977
Mailing Address - Fax:812-853-1705
Practice Address - Street 1:8011 ROBIN HILL RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3083
Practice Address - Country:US
Practice Address - Phone:812-853-2977
Practice Address - Fax:812-853-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120105431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty