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General NPI Number Information
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NPI Number | 1558451070
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Entity Type | Individual
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Provider Name | JOHN CAIN COSBY JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7346 PARKLANE RD
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City | COLUMBIA
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State | SC
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Zip | 29223-7616
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Country | US
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Telephone | 803-788-6691
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Fax | 803-765-8570
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Provider Business Mailing Address
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Address Line | 745 UNIVERSITY VILLAGE DRIVE
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-0969
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Country | US
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Telephone | 803-754-9160
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Fax | 803-754-9162
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1677
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License Number State | SC
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