1841560794 NPI number — J CRAIG COOK DDS, PC

Table of content: MRS. VILMA ENID ROBLES M.A, M.S, PSYD. (NPI 1780981746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841560794 NPI number — J CRAIG COOK DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J CRAIG COOK DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841560794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 STATE ST
Provider Second Line Business Mailing Address:
SUITE # 407
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47150-4929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-945-9100
Provider Business Mailing Address Fax Number:
812-945-9105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 STATE ST
Provider Second Line Business Practice Location Address:
SUITE # 407
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-4929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-945-9100
Provider Business Practice Location Address Fax Number:
812-945-9105
Provider Enumeration Date:
01/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
ORAL & MAXILLOFACIAL SURGEON
Authorized Official Telephone Number:
812-945-9100

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  12009951 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200333200A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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