Provider Demographics
NPI:1821463050
Name:FOX KIDS DENTISTRY & ORTHODONTICS
Entity Type:Organization
Organization Name:FOX KIDS DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-223-3910
Mailing Address - Street 1:511 SW 10TH AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2732
Mailing Address - Country:US
Mailing Address - Phone:503-223-3910
Mailing Address - Fax:503-223-1123
Practice Address - Street 1:511 SW 10TH AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2732
Practice Address - Country:US
Practice Address - Phone:503-223-3910
Practice Address - Fax:503-223-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty