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NPI Code Detail

MEDICARE: SEAN COOK

MEDICARE: SEAN COOK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD009494AZ

General Provider Information

NPI Number : 1336599521
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN COOK
Provider Business Mailing Address
First Line : 1773 S BALBOA DR
Second Line :
City : GILBERT
State : AZ
Zip : 85295-9053
Country : US
Telephone Number : 480-570-9051
Fax Number :
Provider Business Practice Location Address
First Line : 2919 S ELLSWORTH RD STE 128
Second Line :
City : MESA
State : AZ
Zip : 85212-2167
Country : US
Telephone Number : 480-962-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2016
Last Update Date : 05/06/2022

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Directions to “ SEAN COOK ” Practice Location

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