Organization
COOK CHILDRENS PHYSICIAN NETWORK
Active
Parent organization
COOK CHILDRENS PHYSICIAN NETWORK
Other names
Cook Children's Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
COOK CHILDRENS PHYSICIAN NETWORK
Authorized official
MATTHEW V DZURIK MD (PRESIDENT, CCPN)
(682) 885-1416
Entity
Organization
Contact information
Practice address
2600 E BERRY STREET, FORT WORTH, TX 76105-4750
(817) 347-4600
(817) 347-4639
Mailing address
PO BOX 732669, DALLAS, TX 75373-2669
(817) 347-4600
(817) 347-4639
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1404428A9
DE1
TX
Enumeration date
05/19/2014
Last updated
06/29/2021
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