| 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 |
|---|---|
| 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 |