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General NPI Number Information
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NPI Number | 1861965998
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Entity Type | Individual
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Provider Name | SHANEL W COOK
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Gender | Female
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 4633 175TH PL
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-4530
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Country | US
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Telephone | 312-312-3923
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Fax |
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Provider Business Mailing Address
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Address Line | 4633 175TH PL
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-4530
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Country | US
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Telephone | 312-312-3923
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.026431
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License Number State | OH
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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 | 34837
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 34837
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License Number State | TX
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