Individual
DR. GEORGE ROBERT COOPER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2121 E DUPONT RD, SUITE E, FORT WAYNE, IN 46825
(260) 489-1508
Mailing address
2121 E DUPONT RD STE E, FORT WAYNE, IN 46825-1546
(260) 489-1508
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012761A
IN
Other
Enumeration date
06/27/2017
Last updated
07/21/2022
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