Provider Demographics
NPI:1427191030
Name:COOK, TRACEY Y (DDS)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:Y
Last Name:COOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 C ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4521
Mailing Address - Country:US
Mailing Address - Phone:530-753-2845
Mailing Address - Fax:530-753-1397
Practice Address - Street 1:227 C ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4521
Practice Address - Country:US
Practice Address - Phone:530-753-2845
Practice Address - Fax:530-753-1397
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice