Provider Demographics
NPI:1437824828
Name:COOK, CONRAD E VI (DDS)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:E
Last Name:COOK
Suffix:VI
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 1:401 E STONE AVE APT 421
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-1763
Mailing Address - Country:US
Mailing Address - Phone:205-908-2860
Mailing Address - Fax:
Practice Address - Street 1:305 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-1648
Practice Address - Country:US
Practice Address - Phone:864-476-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice