Provider Demographics
NPI:1073645255
Name:COZAD, REYMAN THOMAS (DDS)
Entity Type:Individual
Prefix:MR
First Name:REYMAN
Middle Name:THOMAS
Last Name:COZAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 W 9000 S STE I
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8958
Mailing Address - Country:US
Mailing Address - Phone:801-260-1131
Mailing Address - Fax:801-260-1597
Practice Address - Street 1:3961 W 9000 S STE I
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8958
Practice Address - Country:US
Practice Address - Phone:801-260-1131
Practice Address - Fax:801-260-1597
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT497677399221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice