Healthcare Provider Details

I. General information

NPI: 1649626821
Provider Name (Legal Business Name): COOK FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 4TH ST SE
AUBURN WA
98002-5500
US

IV. Provider business mailing address

321 4TH ST SE
AUBURN WA
98002-5500
US

V. Phone/Fax

Practice location:
  • Phone: 253-735-1106
  • Fax: 253-735-5440
Mailing address:
  • Phone: 253-735-1106
  • Fax: 253-735-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10658
License Number StateWA

VIII. Authorized Official

Name: DR. AMY COOK
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 253-735-1106