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General NPI Number Information
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NPI Number | 1922110147
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Entity Type | Organization
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Legal Business Name | SUGARLAND DENTAL PC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 941A SUGARLAND DRIVE
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City | SHERIDAN
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State | WY
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Zip | 82801
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Country | US
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Telephone | 307-673-5522
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Fax | 307-673-0658
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Provider Business Mailing Address
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Address Line | 941A SUGARLAND DRIVE
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City | SHERIDAN
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State | WY
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Zip | 82801
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Country | US
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Telephone | 307-673-5522
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Fax | 307-673-0658
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Authorized Official
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Title or Position | PRESIDENT SUGARLAND DENTAL PC
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Name | BRIAN JEFFREY COOK
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Credential | DDS
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Telephone | 307-673-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6291
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1017
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License Number State | AK
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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 | 1030
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License Number State | WY
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