NPI 1114074960 · live from the CMS NPI Registry
Jerry M Cook, DDS
Dentist, Endodontics in Fargo, ND. National Provider Identifier 1114074960, active.
NPI record
| NPI | 1114074960 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Endodontics 1223E0200X |
| Practice location | 4710 Amber Valley Parkway S, Ste A, Fargo, ND 58104 |
| Practice phone | 701-232-1956 |
| Mailing address | 4710 Amber Valley Pkwy S, Ste A, Fargo, ND 58104 |
| Enumerated | January 4, 2007 |
| Last updated | July 10, 2012 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Endodontics primary | 1223E0200X | 1981 (ND) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.