Provider Demographics
NPI:1063639920
Name:COX, RANDALL DEWITT (DDS)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:DEWITT
Last Name:COX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:DEWITT
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-0745
Mailing Address - Country:US
Mailing Address - Phone:940-648-3414
Mailing Address - Fax:817-431-9279
Practice Address - Street 1:114 W 4TH STREET
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-0745
Practice Address - Country:US
Practice Address - Phone:940-648-3414
Practice Address - Fax:817-431-9279
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice