MEDICARE: DR. RAUL COOK DDS,MS

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	1223P0300X	Periodontics	DN18465	FL

General Provider Information

NPI Number	:	1720241797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL COOK DDS,MS

Provider Business Mailing Address
First Line	:	2480 E COMMERCIAL BLVD
Second Line	:	PENTHOUSE 1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4025
Country	:	US
Telephone Number	:	954-771-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 E COMMERCIAL BLVD
Second Line	:	PENTHOUSE 1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4025
Country	:	US
Telephone Number	:	954-771-9090
Fax Number	:

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	12/27/2011

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