Provider Demographics
NPI:1386713857
Name:COZART, WILLIAM IRA (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:IRA
Last Name:COZART
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 1:726 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1530
Mailing Address - Country:US
Mailing Address - Phone:319-234-1819
Mailing Address - Fax:
Practice Address - Street 1:726 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-1530
Practice Address - Country:US
Practice Address - Phone:319-234-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA070251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1220632Medicaid