Active NPI
Jerry M Cook, DDS
- Endodontics
- Fargo, ND
National Provider Identifier
1114074960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 1981
- Practice address
- 4710 Amber Valley Parkway S, Ste a
Fargo, ND 58104 - Phone
- (701) 232-1956
- Fax
- (701) 232-2226
- NPI assigned
- Jan 4, 2007
- Last updated
- Jul 10, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 1981 | ND | Primary |
Addresses
Primary practice location
4710 Amber Valley Parkway S, Ste a
Fargo, ND 58104
Mailing address
4710 Amber Valley Pkwy S, Ste a
Fargo, ND 58104
Phone (701) 232-1956
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 949321 | Other | ND | BLUE CROSS BLUE SHIELD OF |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook Endodontics, PC | Endodontics | Past | Accepting new patients |
| Cook Endodontics, PC | Endodontics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Endodontics
- Fargo, ND
- NPI 1437530318
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341878400000",
"number": "1114074960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4710 AMBER VALLEY PKWY S, STE A",
"city": "FARGO",
"state": "ND",
"postal_code": "58104",
"telephone_number": "701-232-1956",
"fax_number": "701-232-2226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4710 AMBER VALLEY PARKWAY S, STE A",
"city": "FARGO",
"state": "ND",
"postal_code": "58104",
"telephone_number": "701-232-1956",
"fax_number": "701-232-2226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOK",
"first_name": "JERRY",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2012-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "ND",
"license": "1981",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF",
"identifier": "949321",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.