Provider Demographics
NPI:1619190360
Name:COOK, BRUCE D (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
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 1:125 CHENOWETH LANE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2641
Mailing Address - Country:US
Mailing Address - Phone:502-897-5454
Mailing Address - Fax:
Practice Address - Street 1:125 CHENOWETH LANE
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2641
Practice Address - Country:US
Practice Address - Phone:502-897-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice