MEDICARE: PAUL ANDREW 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	1223G0001X	General Practice Dentistry	7685	WA

General Provider Information

NPI Number	:	1639254899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANDREW COOK DDS

Provider Business Mailing Address
First Line	:	1207 N 200TH ST STE 218
Second Line	:
City	:	SHORELINE
State	:	WA
Zip	:	98133-3213
Country	:	US
Telephone Number	:	206-546-4186
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 N 200TH ST STE 218
Second Line	:
City	:	SHORELINE
State	:	WA
Zip	:	98133-3213
Country	:	US
Telephone Number	:	206-546-4186
Fax Number	:

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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