Provider Demographics
NPI:1487049698
Name:MARK A COOK DDS PC
Entity type:Organization
Organization Name:MARK A COOK DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:970-963-3013
Mailing Address - Street 1:60 S 8TH ST SUITE 201
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1929
Mailing Address - Country:US
Mailing Address - Phone:970-963-3013
Mailing Address - Fax:970-963-1513
Practice Address - Street 1:60 S 8TH ST SUITE 201
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1929
Practice Address - Country:US
Practice Address - Phone:970-963-3013
Practice Address - Fax:970-963-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD1-008801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty