Provider Demographics
NPI:1548336365
Name:COOK, JEFFERY B (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:B
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 1:611 EAST BLOOMINGDALE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-684-6279
Mailing Address - Fax:813-684-2189
Practice Address - Street 1:611 EAST BLOOMINGDALE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-684-6279
Practice Address - Fax:813-684-2189
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist