Provider Demographics
NPI:1760773907
Name:ARIZONA DENTAL SLEEP THERAPY
Entity Type:Organization
Organization Name:ARIZONA DENTAL SLEEP THERAPY
Other - Org Name:RONNIE L COOK DDS MSD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:928-855-7700
Mailing Address - Street 1:1845 MCCULLOCH BLVD N STE A1
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5722
Mailing Address - Country:US
Mailing Address - Phone:928-855-7700
Mailing Address - Fax:928-855-7703
Practice Address - Street 1:1845 MCCULLOCH BLVD N STE A1
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5722
Practice Address - Country:US
Practice Address - Phone:928-855-7700
Practice Address - Fax:928-855-7703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA COAST ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ16871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty