# GEORGE R. COOPER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760123343
- **Authorized official:** KELLY C STONE (OFFICE ASSOCIATE)
- **Authorized official phone:** (260) 489-1508

## Contact information

- **Practice address:** 2121 E DUPONT RD STE E, FORT WAYNE, IN 46825-1546
- **Practice address phone:** (260) 489-1508
- **Practice address fax:** (260) 338-2541
- **Mailing address:** 2121 E DUPONT RD STE E, FORT WAYNE, IN 46825-1546
- **Mailing address phone:** (260) 489-1508
- **Mailing address fax:** (260) 338-2541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/06/2022
- **Last updated:** 04/06/2022