Provider Demographics
NPI:1689567968
Name:COX, SAMUEL THOMAS
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:THOMAS
Last Name:COX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 TANNER ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4273
Mailing Address - Country:US
Mailing Address - Phone:573-380-8078
Mailing Address - Fax:
Practice Address - Street 1:404 TANNER ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-4273
Practice Address - Country:US
Practice Address - Phone:573-380-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025019788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist