Provider Demographics
NPI:1174654610
Name:FOX, STEPHEN NILES (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NILES
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 1:546 S BROAD ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6600
Mailing Address - Country:US
Mailing Address - Phone:203-886-0028
Mailing Address - Fax:203-886-0035
Practice Address - Street 1:546 S BROAD ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6600
Practice Address - Country:US
Practice Address - Phone:203-886-0028
Practice Address - Fax:203-886-0035
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT47031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry