Provider Demographics
NPI:1689613887
Name:COOK, CHRISTOPHER JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
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 1:7980 NEW LA GRANGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4767
Mailing Address - Country:US
Mailing Address - Phone:502-412-3636
Mailing Address - Fax:502-412-2827
Practice Address - Street 1:7980 NEW LA GRANGE RD STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4767
Practice Address - Country:US
Practice Address - Phone:502-412-3636
Practice Address - Fax:502-412-2827
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120103381223E0200X
KY70821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics