Provider Demographics
NPI:1235138884
Name:BOOKOUT, JOEL F (DDS)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:F
Last Name:BOOKOUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9373
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-0373
Mailing Address - Country:US
Mailing Address - Phone:423-698-3607
Mailing Address - Fax:
Practice Address - Street 1:4141 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-2465
Practice Address - Country:US
Practice Address - Phone:423-698-3607
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS000043971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice