Provider Demographics
NPI:1891869681
Name:COOKE, THOMAS S III (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:COOKE
Suffix:III
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 1:39 W WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150
Mailing Address - Country:US
Mailing Address - Phone:804-737-7402
Mailing Address - Fax:804-737-5442
Practice Address - Street 1:39 W WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150
Practice Address - Country:US
Practice Address - Phone:804-737-7402
Practice Address - Fax:804-737-5442
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA04618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA204677OtherANTHEM
VA983528OtherUNITED CONCORDIA
VA9178540Medicaid