Provider Demographics
NPI:1629077094
Name:COX, SIDNEY TIMOTHY JR (PHD, DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:TIMOTHY
Last Name:COX
Suffix:JR
Gender:M
Credentials:PHD, DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6988 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3834
Mailing Address - Country:US
Mailing Address - Phone:423-894-6614
Mailing Address - Fax:423-892-6258
Practice Address - Street 1:6988 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3834
Practice Address - Country:US
Practice Address - Phone:423-894-6614
Practice Address - Fax:423-892-6258
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 23111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3221947Medicaid
T74046Medicare UPIN