Provider Demographics
NPI:1740200070
Name:COOK DENTAL CENTER PA
Entity Type:Organization
Organization Name:COOK DENTAL CENTER PA
Other - Org Name:BAY AREA DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GENO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-338-6559
Mailing Address - Street 1:216 I45 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:US
Mailing Address - Phone:281-338-6559
Mailing Address - Fax:281-338-4953
Practice Address - Street 1:216 I45 SOUTH
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-338-6559
Practice Address - Fax:281-338-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty