Provider Demographics
NPI:1548496250
Name:COOK, ROBERT DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
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 1:666 N CALVERT ST APT D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3695
Mailing Address - Country:US
Mailing Address - Phone:443-676-2555
Mailing Address - Fax:
Practice Address - Street 1:705 N SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4120
Practice Address - Country:US
Practice Address - Phone:410-334-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist