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General NPI Number Information
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NPI Number | 1801899620
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Entity Type | Individual
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Provider Name | MICHAEL STACY COOK D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 403 MAIN ST
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City | LEAKESVILLE
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State | MS
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Zip | 39451-6502
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Country | US
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Telephone | 601-394-2467
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Fax | 601-394-2468
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | LEAKESVILLE
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State | MS
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Zip | 39451-0280
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Country | US
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Telephone | 601-394-2467
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Fax | 301-394-2468
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2870-95
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License Number State | MS
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