Organization
FOX RIVER PERIODONTICS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON WILLIAM COOKE DDS,MS (PRESIDENT)
(920) 733-7770
Entity
Organization
Contact information
Practice address
2557B EAST CALUMET ST, APPLETON, WI 54915
(920) 733-7770
(920) 733-7798
Mailing address
2557B EAST CALUMET ST, APPLETON, WI 54915
(920) 733-7770
(920) 733-7798
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
5864-015
WI
Other
Enumeration date
05/23/2007
Last updated
08/22/2020
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