Provider Demographics
NPI:1811009988
Name:COX, DAVID PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:COX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:D
Other - Middle Name:PAUL
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6635 COMANCHE ST
Mailing Address - Street 2:PO BOX Q
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-7523
Mailing Address - Country:US
Mailing Address - Phone:208-267-1718
Mailing Address - Fax:208-267-7739
Practice Address - Street 1:477542 HWY 95 N
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852
Practice Address - Country:US
Practice Address - Phone:208-263-1905
Practice Address - Fax:208-255-1906
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806590100Medicaid
ID002091500Medicare ID - Type Unspecified