Provider Demographics
NPI:1932483336
Name:FOOTBRIDGE FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:FOOTBRIDGE FAMILY DENTISTRY, PA
Other - Org Name:RYAN M. COOK, D.M.D. FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-232-5289
Mailing Address - Street 1:16 MILLS AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4065
Mailing Address - Country:US
Mailing Address - Phone:864-232-5289
Mailing Address - Fax:864-232-9860
Practice Address - Street 1:16 MILLS AVE STE 5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4065
Practice Address - Country:US
Practice Address - Phone:864-232-5289
Practice Address - Fax:864-232-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty