Provider Demographics
NPI:1336369297
Name:COOKE, KATHERINE JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JEAN
Last Name:COOKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:JEAN
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9 DEL PIZZOLI
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0202
Mailing Address - Country:US
Mailing Address - Phone:951-775-2227
Mailing Address - Fax:951-698-7570
Practice Address - Street 1:40250 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:SUITE 119
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-4961
Practice Address - Country:US
Practice Address - Phone:951-698-4426
Practice Address - Fax:951-698-7570
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist