Active NPI
Brian Kelly Cook
- General Practice Dentistry
- North Wilkesboro, NC
National Provider Identifier
1467765321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8984
- Practice address
- 1915 W Park Dr Ste 104
North Wilkesboro, NC 28659-3777 - Phone
- (336) 903-7300
- Fax
- (336) 903-0464
- NPI assigned
- Jul 21, 2010
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8984 | NC | Primary |
Addresses
Primary practice location
1915 W Park Dr Ste 104
North Wilkesboro, NC 28659-3777
Mailing address
1915 W Park Dr Ste 104
North Wilkesboro, NC 28659-3777
Phone (336) 903-7300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191205003165 | AL | Order and Referring Only - Dentist | 6709180870 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8984 | NC | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilkes Dental Consortium Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- N Wilkesboro, NC
- NPI 1184728339
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279670400000",
"number": "1467765321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1915 W PARK DR STE 104",
"city": "NORTH WILKESBORO",
"state": "NC",
"postal_code": "286593777",
"telephone_number": "336-903-7300",
"fax_number": "336-903-0464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1915 W PARK DR STE 104",
"city": "NORTH WILKESBORO",
"state": "NC",
"postal_code": "286593777",
"telephone_number": "336-903-7300",
"fax_number": "336-903-0464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOK",
"first_name": "BRIAN",
"middle_name": "KELLY",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-21",
"last_updated": "2010-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "8984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in North Wilkesboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.