Provider Demographics
NPI:1689819906
Name:COOK, KRISTIN DAWN (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DAWN
Last Name:COOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 SANDY RDG
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5989
Mailing Address - Country:US
Mailing Address - Phone:410-935-0962
Mailing Address - Fax:
Practice Address - Street 1:3201 ROGERS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4279
Practice Address - Country:US
Practice Address - Phone:443-276-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000795122300000X
MD14554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist