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Individual
DR. JASON WILLIAM COOKE
Active
Individual
DR. JASON WILLIAM COOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,MS
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
5864-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134339500
ORGANIZATION NPI
WI
Enumeration date
11/10/2010
Last updated
11/10/2010
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