Provider Demographics
NPI:1497160212
Name:DEANA C COOK, DDS, MS, PLLC
Entity Type:Organization
Organization Name:DEANA C COOK, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:910-256-8486
Mailing Address - Street 1:7028 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3655
Mailing Address - Country:US
Mailing Address - Phone:910-256-8486
Mailing Address - Fax:
Practice Address - Street 1:7028 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3655
Practice Address - Country:US
Practice Address - Phone:910-256-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14314023100671OtherMEDICARE ORDERING AND REFERRING