M. Stacy Cook, Dmd | |
403 Main St Leakesville MS 39451 | |
(601) 394-2467 | |
(601) 394-2468 |
Full Name | M. Stacy Cook, Dmd |
---|---|
Speciality | Dentist |
Location | 403 Main St, Leakesville, Mississippi |
Authorized Official Name and Position | Stacy Wilson (OFFICE MANAGER) |
Authorized Official Contact | 6013942467 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
M. Stacy Cook, Dmd Po Box 280 Leakesville MS 39451-0280 Ph: (601) 394-2467 | M. Stacy Cook, Dmd 403 Main St Leakesville MS 39451 Ph: (601) 394-2467 |
NPI Number | 1073722203 |
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Provider Enumeration Date | 05/22/2007 |
Last Update Date | 04/25/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073722203 | NPI | - | NPPES |
73003671 | Other | AL | BCBS AL |
09015334 | Medicaid | MS | |
425495231B | Other | MS | BCBS OF MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 2870 95 (Mississippi) | Primary |