Healthcare Provider Details

I. General information

NPI: 1275459109
Provider Name (Legal Business Name): BKJM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 S DOBSON RD STE 8
MESA AZ
85202-6455
US

IV. Provider business mailing address

2058 S DOBSON RD STE 8
MESA AZ
85202-6455
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-1400
  • Fax: 480-820-1405
Mailing address:
  • Phone: 480-820-1400
  • Fax: 480-820-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRODIE KEVEN COOK
Title or Position: OWNER
Credential: DMD
Phone: 480-570-2004