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General NPI Number Information
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NPI Number | 1235427618
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Entity Type | Organization
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Legal Business Name | COOK FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 12 PENNINGTON ST SUITE 300
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1026
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Country | US
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Telephone | 302-378-4416
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Fax | 302-378-4486
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Provider Business Mailing Address
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Address Line | 12 PENNINGTON ST SUITE 300
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1026
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Country | US
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Telephone | 302-378-4416
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Fax | 302-378-4486
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MEGAN L. COOK BAJLOVIC
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Credential | D.M.D.
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Telephone | 302-378-4416
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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 | 1287
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 159200305000LIC#2015
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License Number State | DE
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