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General NPI Number Information
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NPI Number | 1649626821
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Entity Type | Organization
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Legal Business Name | COOK FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 321 4TH ST SE
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City | AUBURN
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State | WA
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Zip | 98002-5500
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Country | US
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Telephone | 253-735-1106
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Fax | 253-735-5440
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Provider Business Mailing Address
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Address Line | 321 4TH ST SE
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City | AUBURN
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State | WA
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Zip | 98002-5500
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Country | US
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Telephone | 253-735-1106
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Fax | 253-735-5440
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. AMY COOK
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Credential | DDS
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Telephone | 253-735-1106
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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 | 10658
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License Number State | WA
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