Provider Demographics
NPI:1457607418
Name:COOK, NICOLE WILLIAMS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:WILLIAMS
Last Name:COOK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1012 ZODIAC DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7662
Mailing Address - Country:US
Mailing Address - Phone:606-521-2375
Mailing Address - Fax:
Practice Address - Street 1:1012 ZODIAC DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-7662
Practice Address - Country:US
Practice Address - Phone:606-521-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9193122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist