1811009988 NPI number — DAVID PAUL COX DDS

Table of content: DAVID PAUL COX DDS (NPI 1811009988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811009988 NPI number — DAVID PAUL COX DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COX
Provider First Name:
DAVID
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COX
Provider Other First Name:
D
Provider Other Middle Name:
PAUL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811009988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
477542 US 95
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONDERAY, ID
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-263-1905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
477542 HWY 95 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONDERAY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-263-1905
Provider Business Practice Location Address Fax Number:
208-255-1906
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D3127 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 806590100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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