Provider Demographics
NPI:1366694549
Name:COOK, JONATHAN TODD (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TODD
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 1:1001 MOLALLA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3788
Mailing Address - Country:US
Mailing Address - Phone:503-656-8287
Mailing Address - Fax:503-656-8375
Practice Address - Street 1:1001 MOLALLA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3788
Practice Address - Country:US
Practice Address - Phone:503-656-8287
Practice Address - Fax:503-656-8375
Is Sole Proprietor?:No
Enumeration Date:2008-10-19
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1275610495OtherBUSINESS NPI #