Provider Demographics
NPI:1639279961
Name:FOX, ROBERT JED (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JED
Last Name:FOX
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 1:157 W JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1918
Mailing Address - Country:US
Mailing Address - Phone:585-586-1636
Mailing Address - Fax:585-383-1532
Practice Address - Street 1:157 W JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1918
Practice Address - Country:US
Practice Address - Phone:585-586-1636
Practice Address - Fax:585-383-1532
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0344971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice