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General NPI Number Information
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NPI Number | 1548713092
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Entity Type | Organization
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Legal Business Name | CLIFFORD J COOK DMD PA
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 10437 LAMEY BRIDGE RD STE E
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City | DIBERVILLE
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State | MS
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Zip | 39540-2709
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Country | US
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Telephone | 228-860-7895
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Fax |
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Provider Business Mailing Address
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Address Line | 10437 LAMEY BRIDGE RD STE E
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City | DIBERVILLE
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State | MS
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Zip | 39540-2709
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Country | US
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Telephone | 228-860-7895
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLIFFORD J COOK
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Credential | DMD
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Telephone | 228-388-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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