Organization
BROADWATER DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFFORD J COOK D.M.D. (DENTIST)
(228) 388-3353
Entity
Organization
Contact information
Practice address
2318 PASS RD, STE 9, BILOXI, MS 39531-4044
(228) 388-3353
(228) 388-4696
Mailing address
2318 PASS ROAD, STE 9, BILOXI, MS 39531
(228) 388-3353
(228) 388-4696
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
MS3497-09
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01754550
—
MS
Enumeration date
11/09/2016
Last updated
11/09/2016
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