Provider Demographics
NPI:1013237114
Name:SOOKOO, AUDREY LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LYNN
Last Name:SOOKOO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LYNN
Other - Last Name:KOSIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1302
Mailing Address - Country:US
Mailing Address - Phone:330-923-9944
Mailing Address - Fax:
Practice Address - Street 1:444 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1302
Practice Address - Country:US
Practice Address - Phone:330-923-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300234591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice