Provider Demographics
NPI:1669186722
Name:HENRY W. COOK, DMD, PA
Entity type:Organization
Organization Name:HENRY W. COOK, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-824-1950
Mailing Address - Street 1:142 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3085
Mailing Address - Country:US
Mailing Address - Phone:601-824-1950
Mailing Address - Fax:601-824-1953
Practice Address - Street 1:142 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3085
Practice Address - Country:US
Practice Address - Phone:601-824-1950
Practice Address - Fax:601-824-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty