Active NPI
Bradley Cox, DMD
- General Practice Dentistry
- Marion, IL
National Provider Identifier
1962958686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.030878
- Practice address
- 3115 Williamson County Pkwy
Marion, IL 62959-5235 - Phone
- (618) 969-8600
- Fax
- (618) 997-8978
- NPI assigned
- Sep 1, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.030878 | IL | Primary |
Addresses
Primary practice location
3115 Williamson County Pkwy
Marion, IL 62959-5235
Mailing address
109 California Street
PO Box 577
Carterville, IL 62918-0577
Phone (618) 985-8221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.030878 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1962958686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 CALIFORNIA STREET",
"address_2": "PO BOX 577",
"city": "CARTERVILLE",
"state": "IL",
"postal_code": "629180577",
"telephone_number": "618-985-8221",
"fax_number": "618-985-4635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3115 WILLIAMSON COUNTY PKWY",
"city": "MARION",
"state": "IL",
"postal_code": "629595235",
"telephone_number": "618-969-8600",
"fax_number": "618-997-8978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COX",
"first_name": "BRADLEY",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-01",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.030878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.