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1669106548 NPI number — CANDACE REBEKAH COOK DMD

NPI Number: 1669106548
Health Care Provider/Practitioner: CANDACE REBEKAH COOK DMD

Information about “1669106548” NPI (CANDACE REBEKAH COOK DMD) exists in 1669106548 in HTML format HTML  |  1669106548 in plain Text format TXT  |  1669106548 in PDF (Portable Document Format) PDF  |  1669106548 in an XML format XML  formats.

NPI Number : 1669106548 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669106548",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COOK",
    "FirstName": "CANDACE",
    "MiddleName": "REBEKAH",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "17 7TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLUFFTON",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29910-8702",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "229-206-1726",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "164 BLUFFTON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BLUFFTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29910-6248",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-815-5437",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/15/2022",
    "LastUpdateDate": "08/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DN122781",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "DN122781",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "11192",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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