Provider Demographics
NPI:1053335489
Name:FOX, MIELLE S (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIELLE
Middle Name:S
Last Name:FOX
Suffix:
Gender:F
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 239
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598
Mailing Address - Country:US
Mailing Address - Phone:603-837-9342
Mailing Address - Fax:603-837-2890
Practice Address - Street 1:8 CLOVER LN STE 2
Practice Address - Street 2:
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598-3343
Practice Address - Country:US
Practice Address - Phone:603-837-9342
Practice Address - Fax:603-837-2890
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH44691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3115729Medicaid