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General NPI Number Information
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NPI Number | 1598035214
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Entity Type | Organization
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Legal Business Name | PLEASANT DENTAL PARTNERS PC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 9772 W YEARLING RD STE A1680
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City | PEORIA
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State | AZ
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Zip | 85383-1380
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Country | US
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Telephone | 623-825-0616
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Fax | 623-825-0786
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Provider Business Mailing Address
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Address Line | 9772 W YEARLING RD STE A1680
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City | PEORIA
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State | AZ
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Zip | 85383-1380
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Country | US
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Telephone | 623-825-0616
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Fax | 623-825-0786
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP LUTHER COOKE
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Credential | D.D.S.
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Telephone | 623-825-0616
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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 | D2700
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License Number State | AZ
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