MEDICARE: DR. BRIAN KELLY 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
1	1223G0001X	General Practice Dentistry	8984	NC

General Provider Information

NPI Number	:	1467765321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN KELLY COOK

Provider Business Mailing Address
First Line	:	1915 W PARK DR STE 104
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3777
Country	:	US
Telephone Number	:	336-903-7300
Fax Number	:	336-903-0464

Provider Business Practice Location Address
First Line	:	1915 W PARK DR STE 104
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3777
Country	:	US
Telephone Number	:	336-903-7300
Fax Number	:	336-903-0464

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

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	07/21/2010

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Directions to “ DR. BRIAN KELLY COOK ” Practice Location

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