Healthcare Provider Details

I. General information

NPI: 1407389869
Provider Name (Legal Business Name): ROBERT G COX DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 09/03/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 W UNION HILLS DR STE B190
GLENDALE AZ
85308-1359
US

IV. Provider business mailing address

15225 N 20TH ST
PHOENIX AZ
85022-4053
US

V. Phone/Fax

Practice location:
  • Phone: 602-314-4600
  • Fax:
Mailing address:
  • Phone: 810-280-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD010268
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: