Provider Demographics
NPI:1083415434
Name:COOK, AUSTIN ALAN (DDS)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ALAN
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 1:915 CASEMENT CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1204
Mailing Address - Country:US
Mailing Address - Phone:715-748-2688
Mailing Address - Fax:
Practice Address - Street 1:915 CASEMENT CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1204
Practice Address - Country:US
Practice Address - Phone:715-748-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60001793-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist