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General NPI Number Information
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NPI Number | 1851559629
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Entity Type | Organization
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Legal Business Name | JOHN C COSBY JR DMD PA
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location 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
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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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Provider Business Mailing Address
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Address Line | PO BOX 969
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City | BLYTHEWOOD
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State | SC
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Zip | 29016
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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 | OWNER PRESIDENT
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Name | MR. JOHN C COSBY JR.
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Credential | DMD
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Telephone | 803-754-9160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | SC1677
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License Number State | SC
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