Provider Demographics
NPI:1962773846
Name:COOK, VALANE CONRAD (DMD)
Entity type:Individual
Prefix:
First Name:VALANE
Middle Name:CONRAD
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 1:1109 NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5833
Mailing Address - Country:US
Mailing Address - Phone:214-227-4863
Mailing Address - Fax:214-227-5181
Practice Address - Street 1:1109 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5833
Practice Address - Country:US
Practice Address - Phone:214-227-4863
Practice Address - Fax:214-227-5181
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics