Provider Demographics
NPI:1912083643
Name:COOK, MICHAEL HARVEY (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HARVEY
Last Name:COOK
Suffix:
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:PO BOX 671
Mailing Address - Street 2:109 N 4TH AVE
Mailing Address - City:TEAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:75860
Mailing Address - Country:US
Mailing Address - Phone:254-739-2533
Mailing Address - Fax:254-739-2534
Practice Address - Street 1:109 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860
Practice Address - Country:US
Practice Address - Phone:254-739-2533
Practice Address - Fax:254-739-2534
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist