MEDICARE: DR. JOHN CAIN COSBY JR. DMD

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	1677	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	:	1558451070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CAIN COSBY JR. DMD

Provider Business Mailing Address
First Line	:	745 UNIVERSITY VILLAGE DRIVE
Second Line	:
City	:	BLYTHEWOOD
State	:	SC
Zip	:	29016-0969
Country	:	US
Telephone Number	:	803-754-9160
Fax Number	:	803-754-9162

Provider Business Practice Location Address
First Line	:	7346 PARKLANE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7616
Country	:	US
Telephone Number	:	803-788-6691
Fax Number	:	803-765-8570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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