Provider Demographics
NPI:1568626117
Name:COOK, JONATHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 S DADELAND BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7814
Mailing Address - Country:US
Mailing Address - Phone:305-661-5360
Mailing Address - Fax:
Practice Address - Street 1:9100 S DADELAND BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7814
Practice Address - Country:US
Practice Address - Phone:305-661-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist