Provider Demographics
NPI:1306959929
Name:COX, CHARLES WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
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 1:5005 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2699
Mailing Address - Country:US
Mailing Address - Phone:402-339-3519
Mailing Address - Fax:402-339-8104
Practice Address - Street 1:5005 S 84TH ST
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:NE
Practice Address - Zip Code:68127-2699
Practice Address - Country:US
Practice Address - Phone:402-339-3519
Practice Address - Fax:402-339-8104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470617184-00Medicaid
NENE005420OtherBLUE CROSS BLUE SHIELD
NE470617184-00Medicaid