Provider Demographics
NPI:1962492991
Name:COOK, GEORGE WALKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WALKER
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 1:1701 WHIPPOORWILL CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1669
Mailing Address - Country:US
Mailing Address - Phone:209-578-4031
Mailing Address - Fax:
Practice Address - Street 1:1701 WHIPPOORWILL CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1669
Practice Address - Country:US
Practice Address - Phone:209-578-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist