MEDICARE: PHILIP COOKE D.D.S.

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	D2700	AZ

General Provider Information

NPI Number	:	1245265032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP COOKE D.D.S.

Provider Business Mailing Address
First Line	:	5518 W TONOPAH DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-9103
Country	:	US
Telephone Number	:	603-341-0385
Fax Number	:

Provider Business Practice Location Address
First Line	:	13925 W MEEKER BLVD STE 15
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-4432
Country	:	US
Telephone Number	:	623-556-5006
Fax Number	:	623-556-5564

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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