Provider Demographics
NPI:1922090927
Name:REYNOLDS-COX, MARLENE (DDS)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:REYNOLDS-COX
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 1:16544A BAISLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2517
Mailing Address - Country:US
Mailing Address - Phone:718-723-5656
Mailing Address - Fax:717-723-6017
Practice Address - Street 1:16544A BAISLEY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2517
Practice Address - Country:US
Practice Address - Phone:718-723-5656
Practice Address - Fax:718-723-6017
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0433561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
NY00665274Medicaid
NYU85279Medicare UPIN