Healthcare Provider Details
I. General information
NPI: 1669689287
Provider Name (Legal Business Name): COX DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2415 G ST
BAKERSFIELD CA
93301-2809
US
IV. Provider business mailing address
PO BOX 17179
IRVINE CA
92623-7179
US
V. Phone/Fax
- Phone: 661-323-2527
- Fax: 661-323-8754
- Phone: 949-567-3176
- Fax: 949-567-3185
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1223G0001X |
| Taxonomy | General Practice Dentistry |
| License Number | 26160 |
| License Number State | CA |
VIII. Authorized Official
Name: DR.
WILLIAM
J
COX
Title or Position: PC HOLDER
Credential: DDS
Phone: 949-567-3166