Provider Demographics
NPI:1679850234
Name:COOK, RYAN M (DMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
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:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-0218
Mailing Address - Country:US
Mailing Address - Phone:864-845-3402
Mailing Address - Fax:864-845-3101
Practice Address - Street 1:1122 HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-8904
Practice Address - Country:US
Practice Address - Phone:864-845-3402
Practice Address - Fax:864-845-3101
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38661223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice