Provider Demographics
NPI:1851437057
Name:COOK, ANDREW JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JASON
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 1:250 S CHESTNUT ST STE 30
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3031
Mailing Address - Country:US
Mailing Address - Phone:330-297-7009
Mailing Address - Fax:330-297-0901
Practice Address - Street 1:250 S CHESTNUT ST STE 30
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3031
Practice Address - Country:US
Practice Address - Phone:330-297-7009
Practice Address - Fax:330-297-0901
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice