Provider Demographics
NPI:1558584029
Name:COOK, HEIDI R (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:R
Last Name:COOK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1823
Mailing Address - Country:US
Mailing Address - Phone:919-933-9087
Mailing Address - Fax:
Practice Address - Street 1:301 LLOYD ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1823
Practice Address - Country:US
Practice Address - Phone:919-933-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21088122300000X
NC9007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist