Provider Demographics
NPI:1558085258
Name:FOX, MADISON ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:ROSE
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 1:417 W PEACE ST APT 1025
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5054
Mailing Address - Country:US
Mailing Address - Phone:260-570-5883
Mailing Address - Fax:
Practice Address - Street 1:13700 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6609
Practice Address - Country:US
Practice Address - Phone:984-235-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice