Healthcare Provider Details

I. General information

NPI: 1689613887
Provider Name (Legal Business Name): CHRISTOPHER JOHN COOK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7980 NEW LA GRANGE RD STE 2
LOUISVILLE KY
40222-4767
US

IV. Provider business mailing address

7980 NEW LA GRANGE RD STE 2
LOUISVILLE KY
40222-4767
US

V. Phone/Fax

Practice location:
  • Phone: 502-412-3636
  • Fax: 502-412-2827
Mailing address:
  • Phone: 502-412-3636
  • Fax: 502-412-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12010338
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7082
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: