| Cook Childrens Physician Network | |
|
2600 E Berry Street Fort Worth TX 76105-4750 | |
| (817) 347-4600 | |
| (817) 347-4639 |
| Full Name | Cook Childrens Physician Network |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2600 E Berry Street, Fort Worth, Texas |
| Authorized Official Name and Position | Matthew V Dzurik (PRESIDENT, CCPN) |
| Authorized Official Contact | 6828851416 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cook Childrens Physician Network Po Box 732669 Dallas TX 75373-2669 Ph: (817) 347-4600 | Cook Childrens Physician Network 2600 E Berry Street Fort Worth TX 76105-4750 Ph: (817) 347-4600 |
| NPI Number | 1841601291 |
|---|---|
| Provider Enumeration Date | 05/19/2014 |
| Last Update Date | 06/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841601291 | NPI | - | NPPES |
| 1404428A9 | Other | TX | DE1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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