Provider Demographics
NPI:1063685154
Name:COOK, KATHERINE MONG (DDS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MONG
Last Name:COOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MONG
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1425 BEAVERCREEK RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4076
Mailing Address - Country:US
Mailing Address - Phone:503-655-8471
Mailing Address - Fax:503-655-8595
Practice Address - Street 1:1425 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4076
Practice Address - Country:US
Practice Address - Phone:503-655-8471
Practice Address - Fax:503-655-8595
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist