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General NPI Number Information
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NPI Number | 1720241797
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Entity Type | Individual
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Provider Name | RAUL COOK DDS,MS
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 2480 E COMMERCIAL BLVD PENTHOUSE 1
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4025
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Country | US
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Telephone | 954-771-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 2480 E COMMERCIAL BLVD PENTHOUSE 1
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4025
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Country | US
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Telephone | 954-771-9090
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN18465
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License Number State | FL
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