Provider Demographics
NPI:1942425996
Name:COX, KENNETH LANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LANE
Last Name:COX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:306 E REYNOLDS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2817
Mailing Address - Country:US
Mailing Address - Phone:318-255-1592
Mailing Address - Fax:318-255-5619
Practice Address - Street 1:306 E REYNOLDS DR
Practice Address - Street 2:SUITE B
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2817
Practice Address - Country:US
Practice Address - Phone:318-255-1592
Practice Address - Fax:318-255-5619
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice