Provider Demographics
NPI:1689994824
Name:COX, SAMANTHA TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:COX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 W CAPITOL DR
Mailing Address - Street 2:UNIT E
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2461
Mailing Address - Country:US
Mailing Address - Phone:262-792-1100
Mailing Address - Fax:262-790-1261
Practice Address - Street 1:12455 W CAPITOL DR
Practice Address - Street 2:UNIT E
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2461
Practice Address - Country:US
Practice Address - Phone:262-792-1100
Practice Address - Fax:262-790-1261
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI6562-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program