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General NPI Number Information
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NPI Number | 1568109940
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Entity Type | Individual
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Provider Name | CODY MICHAEL COOK
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Gender | Male
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 260 HAMILTON CROSSING DR
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City | ALCOA
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State | TN
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Zip | 37701-2262
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Country | US
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Telephone | 865-223-8739
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 TRAILRIDGE CIR
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City | MOUNT JULIET
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State | TN
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Zip | 37122-4515
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Country | US
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Telephone | 615-438-7097
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11924
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License Number State | TN
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