Provider Demographics
NPI:1043448517
Name:FOX, MATTHEW ALLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLYN
Last Name:FOX
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 1:3228 LITHIA PINECREST RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596
Mailing Address - Country:US
Mailing Address - Phone:813-654-2334
Mailing Address - Fax:813-655-0646
Practice Address - Street 1:3228 LITHIA PINECREST RD
Practice Address - Street 2:SUITE 104
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596
Practice Address - Country:US
Practice Address - Phone:813-654-2334
Practice Address - Fax:813-655-0646
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist