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General NPI Number Information
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NPI Number | 1396866026
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Entity Type | Organization
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Legal Business Name | KEVIN B. COOK, D.D.S., S.C.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1800 STATE ROAD 16
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City | LA CROSSE
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State | WI
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Zip | 54601-3011
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Country | US
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Telephone | 608-782-9667
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 STATE ROAD 16
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City | LA CROSSE
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State | WI
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Zip | 54601-3011
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Country | US
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Telephone | 608-782-9667
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND TREASURER
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Name | DR. KEVIN BURTON COOK
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Credential | D.D.S.
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Telephone | 608-782-9667
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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 | 3279
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License Number State | WI
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