Healthcare Provider Details

I. General information

NPI: 1396848420
Provider Name (Legal Business Name): WILLIAM BRIAN COOK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY 501 S. PRESTON ST.
LOUISVILLE KY
40292-0001
US

IV. Provider business mailing address

UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY 501 S. PRESTON ST.
LOUISVILLE KY
40292-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5128
  • Fax: 502-852-7163
Mailing address:
  • Phone: 502-852-5128
  • Fax: 502-852-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7000
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: