Provider Demographics
NPI:1316012941
Name:COX, KEVIN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:COX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 WALLACE CT.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2462
Mailing Address - Country:US
Mailing Address - Phone:270-936-8050
Mailing Address - Fax:270-936-8584
Practice Address - Street 1:1818 WALLACE CT.
Practice Address - Street 2:SUITE 401
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2462
Practice Address - Country:US
Practice Address - Phone:270-936-8050
Practice Address - Fax:270-936-8584
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002417Medicaid