1346263613 NPI number — LOREN S COOK DMD PLLC

Table of content: (NPI 1346263613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346263613 NPI number — LOREN S COOK DMD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOREN S COOK DMD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346263613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 S MAIN STREET
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
BLACKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24060-5208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-951-8383
Provider Business Mailing Address Fax Number:
540-953-5030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 S MAIN STREET
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BLACKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24060-5208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-951-8383
Provider Business Practice Location Address Fax Number:
540-953-5030
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
LOREN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
DENTIST/OWNER/PRESIDENT
Authorized Official Telephone Number:
540-951-8383

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  401006217 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 0401412480 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 0401006217 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 0401412653 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013321 . This is a "DORAL DENTAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9225146 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 229986 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9220900 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007820861 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01321 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6217 . This is a "DELTA DENTAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 001494067 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0494067 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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