Provider Demographics
NPI:1861527830
Name:COOK, CASEY BOYEA (DMD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:BOYEA
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 1:51 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2731
Mailing Address - Country:US
Mailing Address - Phone:617-623-6767
Mailing Address - Fax:617-666-3033
Practice Address - Street 1:51 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2731
Practice Address - Country:US
Practice Address - Phone:617-623-6767
Practice Address - Fax:617-666-3033
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11156OtherBLUE CROSS BLUE SHIELD