Provider Demographics
NPI:1023128881
Name:COX, JACK MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:MARK
Last Name:COX
Suffix:
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 1:2109 W TEXAS
Mailing Address - Street 2:SUITE D
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6500
Mailing Address - Country:US
Mailing Address - Phone:432-684-4012
Mailing Address - Fax:432-684-6671
Practice Address - Street 1:2109 W TEXAS
Practice Address - Street 2:SUITE D
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6500
Practice Address - Country:US
Practice Address - Phone:432-684-4012
Practice Address - Fax:432-684-6671
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD 115591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice