Provider Demographics
NPI: | 1467496893 |
---|---|
Name: | WILLIAM COX DENTAL CORPORATION |
Entity Type: | Organization |
Organization Name: | WILLIAM COX DENTAL CORPORATION |
Other - Org Name: | GENTLE DENTAL PETALUMA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PC OWNER/PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | COX |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 800-684-6440 |
Mailing Address - Street 1: | 9800 S LA CIENEGA BLVD |
Mailing Address - Street 2: | STE 899, ROOM 1 |
Mailing Address - City: | INGLEWOOD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90301-4440 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-684-6440 |
Mailing Address - Fax: | 360-449-5715 |
Practice Address - Street 1: | 249 N MCDOWELL BLVD |
Practice Address - Street 2: | |
Practice Address - City: | PETALUMA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94954-2306 |
Practice Address - Country: | US |
Practice Address - Phone: | 707-765-9262 |
Practice Address - Fax: | 707-765-9261 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-15 |
Last Update Date: | 2018-10-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |