Healthcare Provider Details

I. General information

NPI: 1164873014
Provider Name (Legal Business Name): COX DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E BIRCH ST STE A
BREA CA
92821-5704
US

IV. Provider business mailing address

1101 SE TECH CENTER DRIVE STE 195
VANCOUVER WA
98683-5511
US

V. Phone/Fax

Practice location:
  • Phone: 714-332-1006
  • Fax: 714-482-0125
Mailing address:
  • Phone: 800-684-6440
  • Fax: 877-725-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26160
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM J COX
Title or Position: PRESIDENT
Credential: DDS
Phone: 800-684-6440