Provider Demographics
NPI:1790850402
Name:COOKE, STEPHEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:COOKE
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 1:25117 DETROIT ROAD
Mailing Address - Street 2:SUITE #230
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2529
Mailing Address - Country:US
Mailing Address - Phone:440-892-4600
Mailing Address - Fax:440-892-4662
Practice Address - Street 1:25117 DETROIT ROAD
Practice Address - Street 2:SUITE #230
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2529
Practice Address - Country:US
Practice Address - Phone:440-892-4600
Practice Address - Fax:440-892-4662
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist