Healthcare Provider Details

I. General information

NPI: 1760691174
Provider Name (Legal Business Name): COX DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 NORTH PERRIS BLVD SUITE F-1
PERRIS CA
92571-3226
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 951-657-6466
  • Fax: 951-657-1886
Mailing address:
  • Phone: 800-684-6440
  • Fax: 877-725-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43359
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26160
License Number StateCA

VIII. Authorized Official

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