Provider Demographics
NPI:1548597966
Name:MICHAEL J. FOX, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL J. FOX, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-494-8666
Mailing Address - Street 1:10010 E 81ST ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4556
Mailing Address - Country:US
Mailing Address - Phone:918-494-8666
Mailing Address - Fax:918-494-6702
Practice Address - Street 1:10010 E 81ST ST
Practice Address - Street 2:STE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4556
Practice Address - Country:US
Practice Address - Phone:918-494-8666
Practice Address - Fax:918-494-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5462261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental