Provider Demographics
NPI:1164502118
Name:COX, TIMOTHY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
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 1:14825 BALLANTYNE VILLAGE WAY STE 280
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4290
Mailing Address - Country:US
Mailing Address - Phone:704-369-5200
Mailing Address - Fax:704-369-5203
Practice Address - Street 1:14825 BALLANTYNE VILLAGE WAY STE 280
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4290
Practice Address - Country:US
Practice Address - Phone:704-369-5200
Practice Address - Fax:704-369-5203
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899012WMedicaid
NC899012WMedicaid