Provider Demographics
NPI:1285908251
Name:DR. TERENCE A.COOK, D.D.S. M.A.G.D.P.C.
Entity type:Organization
Organization Name:DR. TERENCE A.COOK, D.D.S. M.A.G.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:ALYSIOUS
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-856-3343
Mailing Address - Street 1:113 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-1319
Mailing Address - Country:US
Mailing Address - Phone:903-856-3343
Mailing Address - Fax:903-856-3343
Practice Address - Street 1:113 NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1319
Practice Address - Country:US
Practice Address - Phone:903-856-3343
Practice Address - Fax:903-856-3343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. TERENCE A. COOK,D.D.S.,M.A.G.D.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009386601Medicaid