Provider Demographics
NPI:1528294170
Name:COOK, KEVIN T (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:COOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W LIBERTY RD STE E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9700
Mailing Address - Country:US
Mailing Address - Phone:734-663-0854
Mailing Address - Fax:734-663-1374
Practice Address - Street 1:3200 W LIBERTY RD STE E
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9700
Practice Address - Country:US
Practice Address - Phone:734-663-0854
Practice Address - Fax:734-663-1374
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010200011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice