Individual provider Active NPI

Craig R. Cooksley, DDS

  • Pediatric Dentistry
  • Rapid City, SD
National Provider Identifier
1528091618
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
M640 Issued in SD
Practice address
700 Sheridan Lake Rd
Rapid City, SD 57702-2407
Phone
(605) 341-3068
Fax
(605) 341-5757
NPI assigned
Jul 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X M640 SD Primary

Addresses

Primary practice location

700 Sheridan Lake Rd
Rapid City, SD 57702-2407

Mailing address

700 Sheridan Lake Rd
Rapid City, SD 57702-2407
Phone (605) 341-3068

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

State licenses

LicenseStateTypeSpecialty
M640SDMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Black Hills Pediatric Dentistry Pediatric Dentistry PastSince Sep 4, 2022 Accepting new patients
Black Hills Pediatric Dentistry Pediatric Dentistry 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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405468800000",
    "number": "1528091618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SHERIDAN LAKE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022407",
            "telephone_number": "605-341-3068",
            "fax_number": "605-341-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SHERIDAN LAKE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022407",
            "telephone_number": "605-341-3068",
            "fax_number": "605-341-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOKSLEY",
        "first_name": "CRAIG",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2014-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SD",
            "license": "M640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.