Provider Demographics
NPI:1346380722
Name:COOK, TAMMY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1641
Mailing Address - Country:US
Mailing Address - Phone:207-442-7581
Mailing Address - Fax:207-442-7531
Practice Address - Street 1:304 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1641
Practice Address - Country:US
Practice Address - Phone:207-442-7581
Practice Address - Fax:207-442-7531
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice