Provider Demographics
NPI:1750465076
Name:COX, KEVIN GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GLENN
Last Name:COX
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 1:975 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1814
Mailing Address - Country:US
Mailing Address - Phone:801-773-5914
Mailing Address - Fax:801-773-5914
Practice Address - Street 1:975 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1814
Practice Address - Country:US
Practice Address - Phone:801-773-5914
Practice Address - Fax:801-773-5914
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5156247-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice