Provider Demographics
NPI:1922189273
Name:COX, CHARLIE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:
Last Name:COX
Suffix:JR
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 1:1970 W BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6078
Mailing Address - Country:US
Mailing Address - Phone:765-868-2222
Mailing Address - Fax:765-868-8119
Practice Address - Street 1:1970 W BOULEVARD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6078
Practice Address - Country:US
Practice Address - Phone:765-868-2222
Practice Address - Fax:765-868-8119
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120074591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN82983Medicare UPIN
IN218220AMedicare ID - Type Unspecified