Provider Demographics
NPI:1528235215
Name:COOK DENTAL CARE PC
Entity type:Organization
Organization Name:COOK DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-322-3218
Mailing Address - Street 1:1190 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3665
Mailing Address - Country:US
Mailing Address - Phone:706-322-3218
Mailing Address - Fax:706-322-3219
Practice Address - Street 1:1190 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3665
Practice Address - Country:US
Practice Address - Phone:706-322-3218
Practice Address - Fax:706-322-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0119541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102653460AMedicaid