Provider Demographics
NPI:1730342676
Name:COOK, JEREMIAH BOND (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:BOND
Last Name:COOK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5858 W MAIN ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4193
Mailing Address - Country:US
Mailing Address - Phone:469-888-4315
Mailing Address - Fax:
Practice Address - Street 1:5858 W MAIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4193
Practice Address - Country:US
Practice Address - Phone:469-888-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0023833122300000X
TX238331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist