Provider Demographics
NPI:1710188776
Name:COOK, CHRISTOPHER REED (RDH)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:REED
Last Name:COOK
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CHESTNUT AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-5000
Mailing Address - Country:US
Mailing Address - Phone:760-729-1930
Mailing Address - Fax:
Practice Address - Street 1:647 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2825
Practice Address - Country:US
Practice Address - Phone:949-493-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21206124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist