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Organization

MICHAEL R. COX D.D.S. P.L.L.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS STEFANIE PHILLENA GROGG (OFFICE MANAGER)
(304) 485-7717
Entity
Organization

Contact information

Practice address
3705 EMERSON AVE., PARKERSBURG, WV 26104
(304) 485-7717
(304) 428-4755
Mailing address
3705 EMERSON AVE, PARKERSBURG, WV 26104-1118
(304) 485-7717
(304) 428-4755

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4123
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001464019
BLUE CROSS BLUE SHIELD
05
4004033-000
WV
Enumeration date
03/29/2017
Last updated
03/29/2017
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