1538558788 NPI number — WILLIAM COX DENTAL CORPORATION

Table of content: (NPI 1538558788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538558788 NPI number — WILLIAM COX DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM 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:
Provider Other Organization Name Type Code:
6
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:
1538558788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800 S LA CIENEGA BLVD
Provider Second Line Business Mailing Address:
STE 899, ROOM 1
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90301-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-684-6440
Provider Business Mailing Address Fax Number:
360-449-5715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11430 SAN PABLO AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
EL CERRITO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94530-1969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-974-2035
Provider Business Practice Location Address Fax Number:
510-237-0258
Provider Enumeration Date:
01/12/2015

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  46022 , 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)





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