MEDICARE: DR. HEATHER H COX D.D.S.

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	1223G0001X	General Practice Dentistry	5536	OK

General Provider Information

NPI Number	:	1821012667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER H COX D.D.S.

Provider Business Mailing Address
First Line	:	5701 N PORTLAND AVE
Second Line	:	STE 121
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1678
Country	:	US
Telephone Number	:	405-604-6400
Fax Number	:	405-604-4229

Provider Business Practice Location Address
First Line	:	5701 N PORTLAND AVE
Second Line	:	STE 121
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1678
Country	:	US
Telephone Number	:	405-604-6400
Fax Number	:	405-604-4229

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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