Provider Demographics
NPI:1326139452
Name:COOK, DESTRY BRANDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DESTRY
Middle Name:BRANDON
Last Name:COOK
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 1:2525 W CAREFREE HWY
Mailing Address - Street 2:BUILDING 2, SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6093
Mailing Address - Country:US
Mailing Address - Phone:623-533-5699
Mailing Address - Fax:623-533-5832
Practice Address - Street 1:2525 W CAREFREE HWY
Practice Address - Street 2:BUILDING 2, SUITE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6093
Practice Address - Country:US
Practice Address - Phone:623-533-5699
Practice Address - Fax:623-533-5832
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice