Provider Demographics
NPI:1467479030
Name:COOK, GREG S (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
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 1:134 N RANKIN RD
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2525
Mailing Address - Country:US
Mailing Address - Phone:865-379-7555
Mailing Address - Fax:865-379-7205
Practice Address - Street 1:134 N RANKIN RD
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2525
Practice Address - Country:US
Practice Address - Phone:865-379-7555
Practice Address - Fax:865-379-7205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0069671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice