Provider Demographics
NPI:1568109940
Name:COOK, CODY MICHAEL
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:MICHAEL
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 TRAILRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4515
Mailing Address - Country:US
Mailing Address - Phone:615-438-7097
Mailing Address - Fax:
Practice Address - Street 1:260 HAMILTON CROSSING DR
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2262
Practice Address - Country:US
Practice Address - Phone:865-223-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist