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General NPI Number Information
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NPI Number | 1780121319
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Entity Type | Organization
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Legal Business Name | OKEMOS FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 2277 SCIENCE PKWY STE 3
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City | OKEMOS
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State | MI
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Zip | 48864-2551
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Country | US
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Telephone | 517-349-6669
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Fax | 517-349-5064
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Provider Business Mailing Address
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Address Line | 2277 SCIENCE PKWY STE 3
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City | OKEMOS
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State | MI
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Zip | 48864-2551
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Country | US
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Telephone | 517-349-6669
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Fax | 517-349-5064
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN R COOK
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Credential | DDS
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Telephone | 517-349-6669
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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 | 2901020108
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901019571
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License Number State | MI
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