Provider Demographics
NPI:1760691174
Name:COX DENTAL CORPORATION
Entity Type:Organization
Organization Name:COX DENTAL CORPORATION
Other - Org Name:DBA GENTLE DENTAL PERRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-684-6440
Mailing Address - Street 1:1101 SE TECH CENTER DRIVE
Mailing Address - Street 2:STE 195
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5511
Mailing Address - Country:US
Mailing Address - Phone:800-684-6440
Mailing Address - Fax:877-725-7443
Practice Address - Street 1:2560 NORTH PERRIS BLVD
Practice Address - Street 2:SUITE F-1
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3226
Practice Address - Country:US
Practice Address - Phone:951-657-6466
Practice Address - Fax:951-657-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433591223G0001X
CA261601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty