Provider Demographics
NPI:1952450587
Name:COOK, JAY WH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:WH
Last Name:COOK
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 1:10346 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2672
Mailing Address - Country:US
Mailing Address - Phone:913-381-2600
Mailing Address - Fax:913-381-0515
Practice Address - Street 1:10346 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-2672
Practice Address - Country:US
Practice Address - Phone:913-381-2600
Practice Address - Fax:913-381-0515
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS64761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice