Provider Demographics
NPI:1982808119
Name:COX, ALLEN B JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:B
Last Name:COX
Suffix:JR
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:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1199
Mailing Address - Country:US
Mailing Address - Phone:707-884-3738
Mailing Address - Fax:707-884-4946
Practice Address - Street 1:38460 S. HIGHWAY ONE
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-1199
Practice Address - Country:US
Practice Address - Phone:707-884-3738
Practice Address - Fax:707-884-4946
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice