Provider Demographics
NPI:1538850789
Name:COOK, JOHN COLTEN (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:COLTEN
Last Name:COOK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 HUCKLEBERRY TRAIL
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044
Mailing Address - Country:US
Mailing Address - Phone:801-709-3024
Mailing Address - Fax:
Practice Address - Street 1:505 N 14TH ST STE B
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5000
Practice Address - Country:US
Practice Address - Phone:580-336-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice