Provider Demographics
NPI:1528218583
Name:COZBY, MATTHEW JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOEL
Last Name:COZBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9013 KEY PENINSULA HWY N
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-8518
Mailing Address - Country:US
Mailing Address - Phone:253-884-9455
Mailing Address - Fax:253-884-9466
Practice Address - Street 1:9013 KEY PENINSULA HWY N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-8518
Practice Address - Country:US
Practice Address - Phone:253-884-9455
Practice Address - Fax:253-884-9466
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603696511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice