Provider Demographics
NPI:1467548081
Name:COOK, DEVON R (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:DEVON
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 EAGLE CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8157
Mailing Address - Country:US
Mailing Address - Phone:812-402-3485
Mailing Address - Fax:812-402-3482
Practice Address - Street 1:7321 EAGLE CREST BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8157
Practice Address - Country:US
Practice Address - Phone:812-402-3485
Practice Address - Fax:812-402-3482
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010257A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics