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General NPI Number Information
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NPI Number | 1184928632
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Entity Type | Organization
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Legal Business Name | COOK FAMILY DENTISTRY, P.A.
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 2441 HWY 98 W STE 107
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-622-2226
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Fax | 850-622-2246
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Provider Business Mailing Address
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Address Line | 2441 HWY 98 W STE 107
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-622-2226
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Fax | 850-622-2246
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CASSIDY TAYLOR COOK
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Credential | D.M.D.
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Telephone | 850-622-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18378
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License Number State | FL
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