Healthcare Provider Details

I. General information

NPI: 1316159239
Provider Name (Legal Business Name): COX DENTAL PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 3RD AVE
CHULA VISTA CA
91910-3910
US

IV. Provider business mailing address

PO BOX 17179
IRVINE CA
92623-7179
US

V. Phone/Fax

Practice location:
  • Phone: 619-476-1444
  • Fax: 619-476-0656
Mailing address:
  • Phone: 949-567-3176
  • Fax: 949-567-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26160
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM J COX
Title or Position: PC HOLDER
Credential:
Phone: 949-567-3166