Provider Demographics
NPI:1669599478
Name:THOMAS B COOK DDS ORTHODONTICS PA
Entity type:Organization
Organization Name:THOMAS B COOK DDS ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BOWERS
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:207-623-3116
Mailing Address - Street 1:45 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4910
Mailing Address - Country:US
Mailing Address - Phone:207-623-3116
Mailing Address - Fax:207-622-7834
Practice Address - Street 1:45 FULLER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4910
Practice Address - Country:US
Practice Address - Phone:207-623-3116
Practice Address - Fax:207-622-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME25451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty