Provider Demographics
NPI:1891942181
Name:COOKE, DONALD DEWITT (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DEWITT
Last Name:COOKE
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 1:606 DENBIGH BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4435
Mailing Address - Country:US
Mailing Address - Phone:757-874-8612
Mailing Address - Fax:757-243-8372
Practice Address - Street 1:606 DENBIGH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4413
Practice Address - Country:US
Practice Address - Phone:757-874-8612
Practice Address - Fax:757-243-8372
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice