Provider Demographics
NPI:1306928346
Name:COOK, MARK PHILIP (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:PHILIP
Last Name:COOK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SHERMANS DALE
Mailing Address - State:PA
Mailing Address - Zip Code:17090-8540
Mailing Address - Country:US
Mailing Address - Phone:717-582-2333
Mailing Address - Fax:717-582-7516
Practice Address - Street 1:5200 SPRING RD
Practice Address - Street 2:
Practice Address - City:SHERMANS DALE
Practice Address - State:PA
Practice Address - Zip Code:17090-8540
Practice Address - Country:US
Practice Address - Phone:717-582-2333
Practice Address - Fax:717-582-7516
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021907L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice