MEDICARE: JOHN C COSBY JR DMD PA

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	SC1677	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275793648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C COSBY JR DMD PA

Provider Business Mailing Address
First Line	:	7346 PARKLANE ROAD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223
Country	:	US
Telephone Number	:	803-788-6691
Fax Number	:	803-865-6870

Provider Business Practice Location Address
First Line	:	7346 PARKLANE ROAD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223
Country	:	US
Telephone Number	:	803-788-6691
Fax Number	:	803-865-6870

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MR. JOHN C COSBY JR.
Credential	:	DMD
Telephone Number	:	803-754-9160

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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