Provider Demographics
NPI:1710403225
Name:COX, MCKENNA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MCKENNA
Middle Name:A
Last Name:COX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LEIGHTON ST UNIT 717
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1865
Mailing Address - Country:US
Mailing Address - Phone:713-898-3412
Mailing Address - Fax:
Practice Address - Street 1:2181 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-2082
Practice Address - Country:US
Practice Address - Phone:617-606-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18577001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice