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Organization
WAYNE COOK DENTISRTY LLC
Active
Organization
WAYNE COOK DENTISRTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY WAYNE COOK JR. D.D.S. (OWNER)
(870) 739-8799
Entity
Organization
Contact information
Practice address
303 BANCARIO STE 7, MARION, AR 72364-2826
(870) 739-8799
(870) 739-8675
Mailing address
303 BANCARIO STE 7, MARION, AR 72364-2826
(870) 739-8799
(870) 739-8675
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3113
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128223608
—
AR
Enumeration date
12/30/2015
Last updated
12/30/2015
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