Provider Demographics
NPI:1255861993
Name:CRYSTAL R. COX, DDS, MS, PA
Entity Type:Organization
Organization Name:CRYSTAL R. COX, DDS, MS, PA
Other - Org Name:SIGNATURE SMILES ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:252-291-5977
Mailing Address - Street 1:2250 NASH ST N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1729
Mailing Address - Country:US
Mailing Address - Phone:252-291-5977
Mailing Address - Fax:
Practice Address - Street 1:2250 NASH ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1729
Practice Address - Country:US
Practice Address - Phone:252-291-5977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720415276Medicaid