Provider Demographics
NPI:1235427618
Name:COOK FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:COOK FAMILY DENTISTRY, PA
Other - Org Name:COOK FAMILY DENTISTRY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOK BAJLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-378-4416
Mailing Address - Street 1:12 PENNINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1026
Mailing Address - Country:US
Mailing Address - Phone:302-378-4416
Mailing Address - Fax:302-378-4486
Practice Address - Street 1:12 PENNINGTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1026
Practice Address - Country:US
Practice Address - Phone:302-378-4416
Practice Address - Fax:302-378-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE12871223G0001X
DE159200305000LIC#20151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty