Healthcare Provider Details

I. General information

NPI: 1659419802
Provider Name (Legal Business Name): MATTHEW OWEN COX D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8460 S EASTERN AVE SUITE B
LAS VEGAS NV
89123-2864
US

IV. Provider business mailing address

8460 S EASTERN AVE SUITE B
LAS VEGAS NV
89123-2864
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-6688
  • Fax: 702-492-6317
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3722
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: