Provider Demographics
NPI:1891824223
Name:COOK, MICHAEL JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:COOK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 SILVER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3489
Mailing Address - Country:US
Mailing Address - Phone:502-671-0355
Mailing Address - Fax:
Practice Address - Street 1:3221 SILVER SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3489
Practice Address - Country:US
Practice Address - Phone:502-671-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics