MEDICARE: DR. CHRISTOPHER ANDREW COOK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7560	KY
2	122300000X	Dentist	7560	KY

General Provider Information

NPI Number	:	1013059369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER ANDREW COOK DMD

Provider Business Mailing Address
First Line	:	PO BOX 16866
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40256-0866
Country	:	US
Telephone Number	:	502-448-1003
Fax Number	:	502-448-1021

Provider Business Practice Location Address
First Line	:	4516 CANE RUN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-3422
Country	:	US
Telephone Number	:	502-448-1003
Fax Number	:	502-448-1021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/23/2013

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