Provider Demographics
NPI:1669680146
Name:LYMAN, MARK COOKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:COOKE
Last Name:LYMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16611 HWY. R
Mailing Address - Street 2:
Mailing Address - City:MARIBEL
Mailing Address - State:WI
Mailing Address - Zip Code:54227-9752
Mailing Address - Country:US
Mailing Address - Phone:920-863-2324
Mailing Address - Fax:
Practice Address - Street 1:225 HANSEN ST.
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208-0608
Practice Address - Country:US
Practice Address - Phone:920-863-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice