Provider Demographics
NPI:1033539804
Name:FOX, DAVID J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:FOX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:FOXCROFT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-7024
Mailing Address - Country:US
Mailing Address - Phone:215-481-0441
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVE STE 1A8
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3002
Practice Address - Country:US
Practice Address - Phone:215-481-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022175L1223P0300X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS-022175LOtherPENNSYLVANIA DEPARTMENT OF STATE - STATE BOARD OF DENTISTRY