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General NPI Number Information
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NPI Number | 1972164861
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Entity Type | Individual
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Provider Name | MAX LEE COOK DDS
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Gender | Male
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Dates
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Enumeration Date | 06/22/2019
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Last Update Date | 06/22/2019
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Provider Practice Location Address
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Address Line | 5101 HWY 121 # 200
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City | THE COLONY
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State | TX
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Zip | 75056-2601
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Country | US
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Telephone | 469-240-1310
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1552
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City | COLLEYVILLE
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State | TX
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Zip | 76034-1552
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Country | US
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Telephone | 817-914-7958
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 35153
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License Number State | TX
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