Individual
DR. MICHAEL STACY COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
403 MAIN ST, LEAKESVILLE, MS 39451-6502
(601) 394-2467
(601) 394-2468
Mailing address
PO BOX 280, LEAKESVILLE, MS 39451-0280
(601) 394-2467
(301) 394-2468
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2870-95
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015334
—
MS
Enumeration date
05/24/2005
Last updated
11/16/2022
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