Provider Demographics
NPI:1528186137
Name:DANIEL H. COOK
Entity Type:Organization
Organization Name:DANIEL H. COOK
Other - Org Name:PEDIATRIC DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PS
Authorized Official - Phone:253-582-2626
Mailing Address - Street 1:6015 100TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2754
Mailing Address - Country:US
Mailing Address - Phone:253-582-2626
Mailing Address - Fax:253-588-0117
Practice Address - Street 1:6015 100TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2754
Practice Address - Country:US
Practice Address - Phone:253-582-2626
Practice Address - Fax:253-588-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028071Medicaid