Provider Demographics
NPI:1891919882
Name:COOK, RONALD LEON (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LEON
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 1:5189 E INTERSTATE 20 SERVICE RD N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3204
Mailing Address - Country:US
Mailing Address - Phone:817-441-2674
Mailing Address - Fax:817-441-2694
Practice Address - Street 1:5189 E INTERSTATE 20 SERVICE RD N
Practice Address - Street 2:SUITE 102
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3204
Practice Address - Country:US
Practice Address - Phone:817-441-2674
Practice Address - Fax:817-441-2694
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist