MEDICARE: COX DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	26160	CA

General Provider Information

NPI Number	:	1023225695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COX DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1101 SE TECH CENTER DRIVE
Second Line	:	STE 195
City	:	VANCOUVER
State	:	WA
Zip	:	98683-5511
Country	:	US
Telephone Number	:	800-684-6440
Fax Number	:	877-725-7443

Provider Business Practice Location Address
First Line	:	3630 CENTRAL AVE
Second Line	:	STE 6
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-5903
Country	:	US
Telephone Number	:	951-682-1720
Fax Number	:	951-682-5234

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM J COX
Credential	:	DDS
Telephone Number	:	800-684-6440

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	01/08/2020

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