Provider Demographics
NPI:1003057589
Name:COX, JONELLE (DDS)
Entity Type:Individual
Prefix:
First Name:JONELLE
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2903
Mailing Address - Country:US
Mailing Address - Phone:917-604-6748
Mailing Address - Fax:
Practice Address - Street 1:3400 SNYDER AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3961
Practice Address - Country:US
Practice Address - Phone:855-693-7269
Practice Address - Fax:888-864-8390
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02392800122300000X
NY50 054522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist