Provider Demographics
NPI:1104834522
Name:RICHARD J. COOK DDS PC
Entity Type:Organization
Organization Name:RICHARD J. COOK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-3623
Mailing Address - Street 1:712 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1528
Mailing Address - Country:US
Mailing Address - Phone:907-463-3623
Mailing Address - Fax:907-463-1115
Practice Address - Street 1:712 W 12TH ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1528
Practice Address - Country:US
Practice Address - Phone:907-463-3623
Practice Address - Fax:907-463-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK664261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental