Healthcare Provider Details

I. General information

NPI: 1073434429
Provider Name (Legal Business Name): MARIAH COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S 16TH ST
WILMINGTON NC
28401-6608
US

IV. Provider business mailing address

1801 S 16TH ST
WILMINGTON NC
28401-6608
US

V. Phone/Fax

Practice location:
  • Phone: 910-597-3812
  • Fax:
Mailing address:
  • Phone: 910-597-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14904
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: