Provider Demographics
NPI:1295819092
Name:FOXX, JERRY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LYNN
Last Name:FOXX
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 1:7416 S COOPER ST STE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7090
Mailing Address - Country:US
Mailing Address - Phone:817-374-0400
Mailing Address - Fax:817-701-3974
Practice Address - Street 1:1700 COUNTRY CLUB DR
Practice Address - Street 2:SUITE A
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2615
Practice Address - Country:US
Practice Address - Phone:817-473-6227
Practice Address - Fax:817-463-6919
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice