Provider Demographics
NPI:1851595573
Name:COOK, DAVID LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEROY
Last Name:COOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:LEROY
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:CHAUVIN
Mailing Address - State:LA
Mailing Address - Zip Code:70344
Mailing Address - Country:US
Mailing Address - Phone:985-594-4217
Mailing Address - Fax:
Practice Address - Street 1:100 JOHANNA ST
Practice Address - Street 2:
Practice Address - City:CHAUVIN
Practice Address - State:LA
Practice Address - Zip Code:70344
Practice Address - Country:US
Practice Address - Phone:985-594-4217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1840581Medicaid