Provider Demographics
NPI:1962799379
Name:COOKE, CHARLES-THOMAS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHARLES-THOMAS
Middle Name:
Last Name:COOKE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:2700 COLTSGATE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3799
Mailing Address - Country:US
Mailing Address - Phone:704-749-5700
Mailing Address - Fax:704-749-5701
Practice Address - Street 1:2700 COLTSGATE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3799
Practice Address - Country:US
Practice Address - Phone:704-749-5700
Practice Address - Fax:704-749-5701
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0390501223P0221X
NC94831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry