Healthcare Provider Details

I. General information

NPI: 1487749271
Provider Name (Legal Business Name): MATTHEW R COOKE DDS, MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GRAND LELY DR BLDG L
NAPLES FL
34113-1753
US

IV. Provider business mailing address

PO BOX 100426
GAINESVILLE FL
32610-0426
US

V. Phone/Fax

Practice location:
  • Phone: 239-920-4523
  • Fax: 239-417-6254
Mailing address:
  • Phone: 352-273-7638
  • Fax: 352-273-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDS038622
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN29893
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401410191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: