Provider Demographics
NPI:1780896464
Name:BEVERLY B. COZORT, D.D.S., P.A.
Entity type:Organization
Organization Name:BEVERLY B. COZORT, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:COZORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-444-2494
Mailing Address - Street 1:105 BIMINI CT
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-8994
Mailing Address - Country:US
Mailing Address - Phone:252-444-2494
Mailing Address - Fax:252-444-2494
Practice Address - Street 1:218 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4302
Practice Address - Country:US
Practice Address - Phone:252-726-2360
Practice Address - Fax:252-726-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty