Provider Demographics
NPI:1346263613
Name:LOREN S COOK DMD PLLC
Entity Type:Organization
Organization Name:LOREN S COOK DMD PLLC
Other - Org Name:LAWRENCE J. KYLE DDS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:540-951-8383
Mailing Address - Street 1:611 S MAIN STREET
Mailing Address - Street 2:STE A
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5208
Mailing Address - Country:US
Mailing Address - Phone:540-951-8383
Mailing Address - Fax:540-953-5030
Practice Address - Street 1:611 S MAIN STREET
Practice Address - Street 2:STE A
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5208
Practice Address - Country:US
Practice Address - Phone:540-951-8383
Practice Address - Fax:540-953-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401006217122300000X
VA04014124801223G0001X
VA04010062171223G0001X
VA04014126531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA013321OtherDORAL DENTAL
VA9225146Medicaid
VA229986OtherANTHEM BLUE CROSS BLUE SH
VA9220900Medicaid
VA007820861Medicaid
VA01321Medicaid
VA6217OtherDELTA DENTAL
001494067OtherUNITED CONCORDIA
VA0494067OtherUNITED CONCORDIA