Provider Demographics
NPI:1942654884
Name:COX, JOLENE (RDH)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1275
Mailing Address - Country:US
Mailing Address - Phone:207-949-5845
Mailing Address - Fax:207-564-3283
Practice Address - Street 1:5 WINTER ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1022
Practice Address - Country:US
Practice Address - Phone:207-564-3455
Practice Address - Fax:207-564-3283
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3020124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist