Provider Demographics
NPI:1790873040
Name:COOK, HENRY LEE II (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LEE
Last Name:COOK
Suffix:II
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 1:1190 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3527
Mailing Address - Country:US
Mailing Address - Phone:706-322-3218
Mailing Address - Fax:706-322-3219
Practice Address - Street 1:1190 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3527
Practice Address - Country:US
Practice Address - Phone:706-322-3218
Practice Address - Fax:706-322-3219
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA119861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003138190AMedicaid