# COOKEVILLE REGIONAL DENTAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972597300
- **Authorized official:** REGINA ANN JOHNSON CDA, RDA (OFFICE MANAGER)
- **Authorized official phone:** (931) 528-5105

## Contact information

- **Practice address:** 327 N CEDAR AVE, COOKEVILLE, TN 38501-2420
- **Practice address phone:** (931) 528-5105
- **Practice address fax:** (931) 528-5118
- **Mailing address:** PO BOX 357, COOKEVILLE, TN 38503-0357
- **Mailing address phone:** (931) 528-5105
- **Mailing address fax:** (931) 528-5118

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 08/31/2005
- **Last updated:** 01/10/2008