MEDICARE: DR. ELIZABETH ALICE COOK DMD

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	1223P0221X	Pediatric Dentistry	7876	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396741203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ALICE COOK DMD

Provider Business Mailing Address
First Line	:	7741 BALLANTYNE COMMONS PKWY
Second Line	:	SUITE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2442
Country	:	US
Telephone Number	:	704-845-0955
Fax Number	:	704-845-0965

Provider Business Practice Location Address
First Line	:	7741 BALLANTYNE COMMONS PKWY
Second Line	:	SUITE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2442
Country	:	US
Telephone Number	:	704-845-0955
Fax Number	:	704-845-0965

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/26/2008

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