Provider Demographics
NPI:1013059369
Name:COOK, CHRISTOPHER ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:COOK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16866
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40256-0866
Mailing Address - Country:US
Mailing Address - Phone:502-448-1003
Mailing Address - Fax:502-448-1021
Practice Address - Street 1:4516 CANE RUN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3422
Practice Address - Country:US
Practice Address - Phone:502-448-1003
Practice Address - Fax:502-448-1021
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75601223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist