Provider Demographics
NPI:1295969160
Name:COOK BAJLOVIC, MEGAN (DMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COOK BAJLOVIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PENNINGTON ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1026
Mailing Address - Country:US
Mailing Address - Phone:302-378-4416
Mailing Address - Fax:302-378-4486
Practice Address - Street 1:12 PENNINGTON ST
Practice Address - Street 2:SUITE #300
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1026
Practice Address - Country:US
Practice Address - Phone:302-378-4416
Practice Address - Fax:302-378-4486
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE390200000X
DEG1-00012871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program