Provider Demographics
NPI:1750325304
Name:COOK, KEVEN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVEN
Middle Name:T
Last Name:COOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 N GILBERT RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5835
Mailing Address - Country:US
Mailing Address - Phone:480-834-5000
Mailing Address - Fax:480-844-7303
Practice Address - Street 1:944 N GILBERT RD
Practice Address - Street 2:SUITE #104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5835
Practice Address - Country:US
Practice Address - Phone:480-834-5000
Practice Address - Fax:480-844-7303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD28641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice