Provider Demographics
NPI:1487749271
Name:COOKE, MATTHEW R (DDS, MD, MPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:COOKE
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Gender:M
Credentials:DDS, MD, MPH
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Mailing Address - Street 1:PO BOX 100426
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0426
Mailing Address - Country:US
Mailing Address - Phone:352-273-7638
Mailing Address - Fax:352-273-6765
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:SUITE 3189
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261
Practice Address - Country:US
Practice Address - Phone:412-648-9100
Practice Address - Fax:412-383-7862
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS0386221223D0004X, 1223P0221X
VA04014101911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223D0004XDental ProvidersDentistDental Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025956760001Medicaid