Provider Demographics
NPI:1558429803
Name:COX, BRADLEY T (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:T
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 1:3777 HIGHWAY 129 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30564
Mailing Address - Country:US
Mailing Address - Phone:706-219-0033
Mailing Address - Fax:706-219-0048
Practice Address - Street 1:3777 HIGHWAY 129 SOUTH
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30564
Practice Address - Country:US
Practice Address - Phone:706-219-0033
Practice Address - Fax:706-219-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA129341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA962922049AMedicaid