Provider Demographics
NPI:1578697918
Name:FOX, RUSSELL BARRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:BARRY
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 1:299 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-659-3444
Mailing Address - Fax:
Practice Address - Street 1:350 HANCOCK STREET
Practice Address - Street 2:FLOOR 1
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171
Practice Address - Country:US
Practice Address - Phone:617-471-5255
Practice Address - Fax:617-774-6468
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2017-09-20
Deactivation Date:2017-08-08
Deactivation Code:
Reactivation Date:2017-09-20
Provider Licenses
StateLicense IDTaxonomies
MA173991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice