Provider Demographics
NPI:1386710275
Name:COOTHBRUSH INC
Entity type:Organization
Organization Name:COOTHBRUSH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO COOTHBRUSH INC
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MCCOOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-738-2257
Mailing Address - Street 1:545 COUNTRY CLUB RD SE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112
Mailing Address - Country:US
Mailing Address - Phone:812-738-2257
Mailing Address - Fax:812-738-1778
Practice Address - Street 1:545 COUNTRY CLUB RD SE
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112
Practice Address - Country:US
Practice Address - Phone:812-738-2257
Practice Address - Fax:812-738-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120073621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10007512AMedicaid