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NPI Code Detail

MEDICARE: SALLY A COOK RDH

MEDICARE: SALLY A COOK RDH
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
1124Q00000XDental Hygienist003105MO

General Provider Information

NPI Number : 1477686335
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY A COOK RDH
Provider Business Mailing Address
First Line : 2816 E 23RD ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64127-4002
Country : US
Telephone Number : 816-231-3955
Fax Number :
Provider Business Practice Location Address
First Line : 2816 E 23RD ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64127-4002
Country : US
Telephone Number : 816-231-3955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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Directions to “ SALLY A COOK RDH” Practice Location

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