Provider Demographics
NPI:1720241797
Name:COOK, RAUL (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 E COMMERCIAL BLVD
Mailing Address - Street 2:PENTHOUSE 1
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4025
Mailing Address - Country:US
Mailing Address - Phone:954-771-9090
Mailing Address - Fax:
Practice Address - Street 1:2480 E COMMERCIAL BLVD
Practice Address - Street 2:PENTHOUSE 1
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4025
Practice Address - Country:US
Practice Address - Phone:954-771-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN184651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics