Provider Demographics
NPI:1912382078
Name:FOX, DANA (DMD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:PFAFFLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:511 SW 10TH AVE
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry