Provider Demographics
NPI:1912458670
Name:GONZALEZ-COOK, MARIA MERCEDES (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MERCEDES
Last Name:GONZALEZ-COOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 W TONOPAH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9119
Mailing Address - Country:US
Mailing Address - Phone:949-573-4091
Mailing Address - Fax:
Practice Address - Street 1:31796 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6974
Practice Address - Country:US
Practice Address - Phone:949-415-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist