Individual
DR. JASON WILLIAM COOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,MS
Contact information
Practice address
2557B E CALUMET ST, APPLETON, WI 54915-4748
(920) 733-7770
(920) 733-7798
Mailing address
2557B E CALUMET ST, APPLETON, WI 54915-4748
(920) 733-7770
(920) 733-7798
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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