Provider Demographics
NPI:1396107447
Name:COX DAVALOS, JODI MICHELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:MICHELLE
Last Name:COX DAVALOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:MICHELLE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:748 TURNING LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6068
Mailing Address - Country:US
Mailing Address - Phone:229-221-4937
Mailing Address - Fax:
Practice Address - Street 1:215 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757
Practice Address - Country:US
Practice Address - Phone:229-226-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0152811223P0221X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program