Healthcare Provider Details

I. General information

NPI: 1447342548
Provider Name (Legal Business Name): LAWRENCE JOHN COOK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AVENUE AND ROOSEVELT ROAD
HINES IL
60141
US

IV. Provider business mailing address

5TH AVENUE AND ROOSEVELT ROAD
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2332
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9067
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410315
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1000286
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: