Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30.024519 | OH |
Y | 122300000X | Dentist | 3889-16 | MS |
N | 1223E0200X | Endodontist | ENDO-537-17 | MS |
NPI | 1134509813 |
---|---|
Provider Name | Mary Olivia Cook |
First Address | Columbus, OH 43210-1267 |
Second Address | Madison, MS 39110-8161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2015 |
Last Update Date | 30/04/2019 |