1932316502 NPI number — COX DENTAL CORPORATION

Table of content: (NPI 1932316502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932316502 NPI number — COX DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COX DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENTLE DENTAL MISSION VIEJO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932316502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25523 MARGUERITE PKWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92692-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-768-1800
Provider Business Practice Location Address Fax Number:
949-768-0432
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-684-6440

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  26160 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com