Provider Demographics
NPI:1912080532
Name:COOK, PHILLIP MILTON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MILTON
Last Name:COOK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1326
Mailing Address - Country:US
Mailing Address - Phone:757-357-4121
Mailing Address - Fax:757-357-4122
Practice Address - Street 1:309 MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1326
Practice Address - Country:US
Practice Address - Phone:757-357-4121
Practice Address - Fax:757-357-4122
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice