Healthcare Provider Details

I. General information

NPI: 1528218583
Provider Name (Legal Business Name): MATTHEW JOEL COZBY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9013 KEY PENINSULA HWY N
LAKEBAY WA
98349-8518
US

IV. Provider business mailing address

9013 KEY PENINSULA HWY N
LAKEBAY WA
98349-8518
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-9455
  • Fax: 253-884-9466
Mailing address:
  • Phone: 253-884-9455
  • Fax: 253-884-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60369651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: