Provider Demographics
NPI:1497176853
Name:CHARLES G COX JR DMD PA
Entity Type:Organization
Organization Name:CHARLES G COX JR DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWQNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:COX
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-463-2665
Mailing Address - Street 1:216 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3427
Mailing Address - Country:US
Mailing Address - Phone:352-463-2665
Mailing Address - Fax:352-463-6848
Practice Address - Street 1:216 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3427
Practice Address - Country:US
Practice Address - Phone:352-463-2665
Practice Address - Fax:352-463-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty