MEDICARE: CYNTHIA ANN COOK DDS

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	122300000X	Dentist	13072	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13072	OTHER	TX	DENTAL LISCENCE

General Provider Information

NPI Number	:	1417970666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA ANN COOK DDS

Provider Business Mailing Address
First Line	:	7475 SKILLMAN ST STE 105A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-8321
Country	:	US
Telephone Number	:	214-553-1122
Fax Number	:	214-553-5093

Provider Business Practice Location Address
First Line	:	7475 SKILLMAN ST STE 105A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-8321
Country	:	US
Telephone Number	:	214-553-1122
Fax Number	:	214-553-5093

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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