Jeffrey Lane Cook, DMD
Individual provider Active NPI Dentist · Middletown, DE
NPI 1457565830 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1457565830
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 867 (DE)
- Practice address
- 12 Pennington St
Suite 300
Middletown, DE 19709-1021 - Phone
- (302) 478-4416
- Fax
- (303) 478-4886
- NPI assigned
- May 9, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 867 | DE | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 867 | DE | Yes |
Addresses
Primary practice location
12 Pennington St
Suite 300
Middletown, DE 19709-1021
Mailing address
100 E Lanark Dr
Wilmington, DE 19807-1050
Phone (302) 655-9441
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 867 | Other | DE | DELAWARE DENTAL LICENSE # |
Other providers in Middletown, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.