MEDICARE: DR. GREGORY A COOK SR. DDS

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
1	122300000X	Dentist	30016049	OH

General Provider Information

NPI Number	:	1386705531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A COOK SR. DDS

Provider Business Mailing Address
First Line	:	3365 RICHMOND RD
Second Line	:	SUITE 220
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4171
Country	:	US
Telephone Number	:	216-831-1816
Fax Number	:	216-755-1313

Provider Business Practice Location Address
First Line	:	3365 RICHMOND RD
Second Line	:	SUITE 220
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4171
Country	:	US
Telephone Number	:	216-831-1816
Fax Number	:	216-755-1313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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