Provider Demographics
NPI:1154533370
Name:COX, BOOBY NEAL (DDS)
Entity type:Individual
Prefix:
First Name:BOOBY
Middle Name:NEAL
Last Name:COX
Suffix:
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 1:1039 N INDEPENDENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:23348-4992
Mailing Address - Country:US
Mailing Address - Phone:276-773-3281
Mailing Address - Fax:276-773-9139
Practice Address - Street 1:1039 N. INDEPENDENCE AVENUE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348-4992
Practice Address - Country:US
Practice Address - Phone:276-773-3281
Practice Address - Fax:276-773-9139
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist