Provider Demographics
NPI:1821213620
Name:DR JOHN N FOX DDS MS PC
Entity Type:Organization
Organization Name:DR JOHN N FOX DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:573-785-1466
Mailing Address - Street 1:1300 N WESTWOOD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3314
Mailing Address - Country:US
Mailing Address - Phone:573-785-1466
Mailing Address - Fax:573-785-8566
Practice Address - Street 1:1300 N WESTWOOD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3314
Practice Address - Country:US
Practice Address - Phone:573-785-1466
Practice Address - Fax:573-785-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty