Provider Demographics
NPI:1104880012
Name:COX, WILLIAM CLARENCE (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLARENCE
Last Name:COX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-2006
Mailing Address - Country:US
Mailing Address - Phone:618-254-9813
Mailing Address - Fax:618-254-9817
Practice Address - Street 1:22 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-2006
Practice Address - Country:US
Practice Address - Phone:618-254-9813
Practice Address - Fax:618-254-9817
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19156841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice