Provider Demographics
NPI:1669551164
Name:COX, MARK (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:2945 NORTHWOODS WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2136
Mailing Address - Country:US
Mailing Address - Phone:530-221-6900
Mailing Address - Fax:530-221-5396
Practice Address - Street 1:2945 NORTHWOODS WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2136
Practice Address - Country:US
Practice Address - Phone:530-221-6900
Practice Address - Fax:530-221-5396
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV46129Medicare UPIN