Provider Demographics
NPI:1548392053
Name:FOX, GUY LAMAR (DDS)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:LAMAR
Last Name:FOX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 LAKE MURRAY BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3435
Mailing Address - Country:US
Mailing Address - Phone:619-461-5422
Mailing Address - Fax:619-461-5424
Practice Address - Street 1:8312 LAKE MURRAY BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3435
Practice Address - Country:US
Practice Address - Phone:619-461-5422
Practice Address - Fax:619-461-5424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice