Provider Demographics
NPI:1457565830
Name:COOK, JEFFREY LANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LANE
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 1:100 E LANARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-1050
Mailing Address - Country:US
Mailing Address - Phone:302-655-9441
Mailing Address - Fax:302-655-4648
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:19709-1021
Practice Address - Country:US
Practice Address - Phone:302-478-4416
Practice Address - Fax:303-478-4886
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE867OtherDELAWARE DENTAL LICENSE #