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General NPI Number Information
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NPI Number | 1770023830
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Entity Type | Organization
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Legal Business Name | COWETA DENTAL SLEEP THERAPY LLC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 260 S PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1700
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Country | US
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Telephone | 770-486-9400
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Fax | 770-252-6818
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Provider Business Mailing Address
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Address Line | 260 S PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1700
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Country | US
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Telephone | 770-486-9400
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Fax | 770-252-6818
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CLEMMIE TODD COX
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Credential | D.M.D
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Telephone | 770-486-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN011313
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License Number State | GA
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