Healthcare Provider Details

I. General information

NPI: 1821136714
Provider Name (Legal Business Name): DR. DOUK KOOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 EAST CEDAR AVE
GLADWIN MI
48624
US

IV. Provider business mailing address

230 EAST CEDAR AVE
GLADWIN MI
48624
US

V. Phone/Fax

Practice location:
  • Phone: 989-426-4597
  • Fax:
Mailing address:
  • Phone: 989-426-4597
  • Fax: 832-437-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25151
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: