Provider Demographics
NPI:1467131516
Name:COX, SKYLAR RICHARD (DMD)
Entity Type:Individual
Prefix:MR
First Name:SKYLAR
Middle Name:RICHARD
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 1:603 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016-1401
Mailing Address - Country:US
Mailing Address - Phone:217-942-5033
Mailing Address - Fax:
Practice Address - Street 1:603 5TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016-1401
Practice Address - Country:US
Practice Address - Phone:217-942-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190344171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice