Provider Demographics
NPI:1891846200
Name:COZORT, BEVERLY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:B
Last Name:COZORT
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 1:105 BIMINI CT
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-8994
Mailing Address - Country:US
Mailing Address - Phone:252-444-2494
Mailing Address - Fax:252-444-2494
Practice Address - Street 1:218 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4302
Practice Address - Country:US
Practice Address - Phone:252-726-2360
Practice Address - Fax:252-726-2072
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice