Provider Demographics
NPI:1235219817
Name:FOX, STEVEN WARREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WARREN
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 1:206 ELLISON CT
Mailing Address - Street 2:
Mailing Address - City:LEAD
Mailing Address - State:SD
Mailing Address - Zip Code:57754-1758
Mailing Address - Country:US
Mailing Address - Phone:605-584-2482
Mailing Address - Fax:605-584-2482
Practice Address - Street 1:206 ELLISON CT
Practice Address - Street 2:
Practice Address - City:LEAD
Practice Address - State:SD
Practice Address - Zip Code:57754-1758
Practice Address - Country:US
Practice Address - Phone:605-584-2482
Practice Address - Fax:605-584-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7806300Medicaid
SDBF2988206OtherDRUG ID NUMBER