MEDICARE: COX DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26160	CA

General Provider Information

NPI Number	:	1033574470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COX DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1101 SE TECH CENTER DRIVE
Second Line	:	STE 195
City	:	VANCOUVER
State	:	WA
Zip	:	98683-5511
Country	:	US
Telephone Number	:	800-684-6440
Fax Number	:	877-725-7443

Provider Business Practice Location Address
First Line	:	39872 LOS ALAMOS RD
Second Line	:	SUITE A-1
City	:	MURRIETA
State	:	CA
Zip	:	92562-5871
Country	:	US
Telephone Number	:	951-643-6119
Fax Number	:	951-894-5516

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM J COX
Credential	:	DDS
Telephone Number	:	800-684-6440

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	01/08/2020

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